Nonossifying fibroma of the lower femur with genu valgum: a case report.

BACKGROUND: Nonossifying fibroma is common in children and adolescents, and nonossifying fibroma with genu valgum is rare in the clinic. This article evaluated the effectiveness of treatment in a case of nonossifying fibroma of the lower femur with genu valgum. CASE PRESENTATION: A 16-year-old girl complained of pain in the lower part of her right thigh for one year. She was diagnosed as non ossifying fibroma of the right femur with secondary valgus deformity of the right knee, and was treated in our hospital. We performed curettage, bone grafting and internal fixation,and corrected the valgum deformity at the same time. The patient's incision healed well, the pain was disappeared, and the mechanical axis of lower limbs was corrected. No tumor recurrence was found on X- ray examination one year after operation, and the fracture end was healed. The patient could walk normally, and she was satisfied with her limb function. CONCLUSION: Nonossifying fibroma with genu valgum is rare in the clinic. The patient was satisfied with our treatment, which achieved a good curative effect.

TT-TG distance decreases after open wedge distal femoral varization osteotomy in patients with genu valgum & patellar instability. A pilot 3D computed tomography simulation study.

BACKGROUND: Genu valgum is considered to be a risk factor for patellar instability. Correction of valgus alone or combined with a tibial tuberosity medialization has been described. However, changes occurring in the tibial tuberosity-trochlear groove (TT-TG) distance after a lateral distal femoral opening wedge osteotomy (LDF-OWO) are not known. PURPOSE: This study aimed to define changes in TT-TG distance with increasing amounts of valgus correction after LDF-OWO. METHODS: Three-Dimensional Computed Tomography (3D-CT) scans of six patients (two females and four males) aged between 19 and 35 years with genu valgum and patellar instability were analyzed. 3D models of femoral, tibial, and patellar bones were created with the advanced segment option of Mimics 21® software. An oblique lateral opening wedge osteotomy of the distal femur was simulated in 2-degree increments up to 12 degrees of varus opening. Change in TT-TG distance was measured in mm on 3D models of the knee. RESULTS: Compared to baseline without osteotomy, the TT-TG distance decreased significantly (p < 0.05) for all corrections from 2 to 12 degrees in 2° steps. The TT-TG distance decreased by an average of 1.7 mm for every 2 degrees of varus opening. CONCLUSION: Lateral opening wedge distal femoral osteotomy causes a decrease in TT-TG distance. The surgeon should be aware of the magnitude of this change (1.7 mm decrease for every 2° increment of valgus opening).

Single-Stage Correction of Genu Valgum Recurvatum by Distal Femoral and High Tibial Opening Wedge Osteotomies: A Case Report.

CASE: A 32-year-old woman with genu valgum recurvatum presented to clinic complaining of long-standing anterior knee pain. Radiographs demonstrated a 13° anterior tibial slope and 15° valgus malalignment. She underwent a single-stage 2-level osteotomy at the distal femur and proximal tibia to simultaneously correct genu valgum and recurvatum. This procedure achieved precise correction in both planes. At 1 year, the patient was pain-free and ambulated without restriction. CONCLUSION: This procedure should be considered among the available surgical options when treating genu valgum recurvatum because it produced excellent results for the studied patient.

Is lateral femoral condyle hypoplasia a feature of genu valgum? A morphological computed tomography study of 200 knees.

BACKGROUND: Young surgeons are taught that genu valgum deformity is associated with hypoplasia of the lateral femoral condyle, despite the absence of supporting evidence. The objective of this study was to determine whether the lateral condyle was hypoplastic in genu valgum, by assessing the morphological features of the distal femur and their variations according to the severity of the coronal deformity. HYPOTHESIS: The lateral femoral condyle is not hypoplastic in genu valgum deformity. MATERIAL AND METHODS: The 200 included patients treated by unilateral total knee arthroplasty were divided into five groups based on their preoperative hip-knee-ankle (HKA) angle. The HKA angle, valgus cut angle (VCA), and anatomical lateral distal femoral angle (aLDFA) were measured on long-leg radiographs. Computed tomography images were then used to measure the medial and lateral anterior-posterior condylar lengths (mAPCL and lAPCL) and condylar thicknesses (mCT and lCT), distal femoral torsion (DFT), medial and lateral posterior condylar heights (mPCH and lPCH), and medial and lateral condylar volumes (mCV and lCV). RESULTS: No significant differences were demonstrated across the five mechanical-axis groups for mAPCL, lAPCL, mCT, lCT, mPCH, or lPCH. The groups differed significantly regarding the VCA (p<0.0001), aLDFA (p<0.0001), DFT (p<0.0001), and mCV/lCV ratio (p<0.0001). VCA and aLDFA were smaller when the valgus exceeded 10°. DFT was similar in all varus knees (2.2°-2.6°) but significantly greater for knees with moderate (4.0°) or severe (6.2°) valgus. Finally, lCV was greater than mCV in valgus knees compared to varus knees. CONCLUSION: The presence of lateral condyle hypoplasia in knees with genu valgum seems open to question. Apparent hypoplasia noted during the standard physical examination may be chiefly ascribable to distal valgus of the femoral epiphysis in the coronal plane and, with the knee flexed, to distal epiphyseal torsion, whose severity increases with the degree of valgus deformity. These considerations should be taken into account when performing distal femoral cuts for TKA, to ensure the restoration of normal anatomy in patients with genu valgus. LEVEL OF EVIDENCE: IV.

Indications and timing in isolated medial femoral hemiepiphysiodesis for idiopathic genu valgum: A systematic review.

INTRODUCTION: Temporary isolated medial femoral hemiepiphysiodesis (TIMFH) represents a safe and effective technique widely used to treat idiopathic genu valgum. Recent studies mainly concentrated on comparing outcomes of different implants, while less attention has been reserved to the proper indications and timing for surgery. The aim of this systematic review was to provide evidence-based guidelines about indications for device implant and removal and postoperative management. METHODS: A comprehensive literature search was performed across three databases to select articles concerning TIMFH in the treatment of idiopathic genu valgum. Studies involving other etiologies or concomitant surgical procedures were excluded. Quality assessment of the included studies was conducted through the Newcastle-Ottawa Scale. RESULTS: Ten studies involving 237 patients for a total of 446 knees were included in the analysis. Mean age at surgery was 11,4 years. Patients were considered for surgery using various clinical and radiological parameters. Intermalleolar distance (IMD) and mechanical lateral distal femoral angle (mLDFA) were the most common evaluated. Mean treatment time was 12 months. Rebound of the deformity occurred in 6,7% of cases. CONCLUSION: Results of this review showed good consensus among authors. Patients undergoing TIMFH for IGV should be minimum 8 years old, with an IMD greater than 8 cm and a mLDFA lower than 87°. Postoperative management should comprise of quarterly clinic evaluations, and follow-up should last until skeletal maturity. The application of more uniform parameters in clinical practice may improve the establishment of the optimal timing for implant removal.

Genu Valgum After Distal Femur Extension Osteotomy in Children With Cerebral Palsy.

BACKGROUND: Distal femur extension osteotomy (DFEO) is a common treatment for knee flexion contracture and crouch gait in patients with cerebral palsy (CP), but skeletally immature patients tend to develop genu valgum deformities after DFEO. This study aimed to report the tendency of valgus changes after DFEO and determine the risk factors for subsequent surgery for excessive genu valgum. METHODS: This retrospective case-control study included 25 children with CP who underwent DFEO in 44 limbs for knee flexion contractures ≥15 degrees at a mean age of 11.0 years. Radiologic measurements included the anatomic lateral distal femoral angle (aLDFA), anatomic tibiofemoral angle (aTFA), medial proximal tibia angle, and plate-condyle angle, postoperatively and at the latest follow-up. Age, sex, preoperative knee flexion contracture angle, Gross Motor Function Classification System level, and radiographic measurements were compared between children with and without subsequent guided growth for genu valgum. RESULTS: A significant valgus change was observed at the distal femur in the first postoperative year (aLDFA from 83.6 to 80.1 degrees, P<0.001; aTFA from 176.1 to 172.5 degrees, P<0.01; plate-condylar angle from 5.3 to 9.5 degrees, P<0.001). Valgus changes occurred in 36 of the 44 limbs (82%) by an average of -4.6 degrees in the aLDFA, and subsequent guided growth was performed in 5 patients (20%). Guided growth for genu valgum was associated with a greater postoperative valgus angle (aLDFA: 78.0 vs. 84.9 degrees, P<0.01) but not with age, Gross Motor Function Classification System level, or preoperative flexion contracture. CONCLUSIONS: Distal metaphyseal osteotomies and distally placed angled plates near the physis are associated with valgus changes following growth. We recommend making a slight varus alignment during DFEO to compensate for subsequent valgus changes. LEVEL OF EVIDENCE: Level III-therapeutic, retrospective comparative study.

Potential influence of factors for genu valgus with hereditary multiple exostoses.

Genu valgus is one of the most common limb deformities in hereditary multiple exostoses (HME). However, it is easily concealed and may account for subsequent osteoarthritis of the knee. The knees of 56 patients (33 men and 23 women) with HME were investigated bilaterally. Knee valgus was described by the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA). We investigated sex, age, BMI, total number of palpable osteochondromas, number of radiographic osteochondromas around the knee, forearm deformities, morphology and distribution of lesions, and correlations between these factors and genu valgus. The measurement of LDFA and MPTA was performed to identify the sources of genu valgus deformity. Based on the measurement of the mechanical axis, limbs were classified as genu valgus (n = 22) or normal mechanical axis groups (n = 90). The different severities of the genu valgus patients were classified by MAD. By bivariate logistic regression, genu valgus was significantly associated with more sessile and flared metaphyseal lesions. However, only the number of flared metaphyseal lesions had a significant influence on the severity of genu valgus. By analyzing the LDFA and MPTA, it was found that abnormalities of both proximal tibia and distal femur play important roles in genu valgus. Early detection of sessile and flared metaphyseal knee lesions in patients with HME can contribute to early intervention of genu valgus. Level of relevance: Level 2.

Genu Valgum Correction and Biplanar Osteotomies.

Valgus malalignment is an important risk factor in recurrent patella instability. This article explores the role of corrective osteotomy and discusses the various described methods both on the femoral and tibial sides of the joint. A detailed operative technique of medial closing wedge distal femoral osteotomy is included.

Change of limb alignment in Korean children and adolescents with idiopathic genu valgum.

ABSTRACT: There has been no study evaluating the change of limb alignment for patients with genu valgum. The purpose of this study was to investigate the change of limb alignments in children and adolescents with idiopathic genu valgum through evaluating distal femur, proximal tibia, and knee joint line.Consecutive children and adolescents, under the age of 18, with genu valgum were included. Mechanical tibiofemoral angle, mechanical lateral distal femoral angle, mechanical medial proximal tibia angle, and joint line convergence angle were measured. The rate of changes for each radiographic measurement were analyzed using a linear mixed model.A total of 1539 teleroentgenograms from 518 limbs of 273 individuals were included in this study. Linear mixed model showed that the change of limb alignment was significantly associated with age, but not associated with gender and laterality. The mechanical tibiofemoral angle was most valgus initially, decreasing until reaching its lowest value of 2.8° at 10 years old. The mechanical lateral distal femoral angle decreases from initial neutral alignment and increases in valgus continuously. The mechanical medial proximal tibia angle decreases from initial valgus and progresses to be neutral at around the age of 10. The joint line convergence angle decreases sharply from initial valgus alignment to 0° at the age of 5.Valgus alignment in children with idiopathic genu valgum decreases until approximately the age of 10. In younger children, the tibia and joint line contribute most to overall valgus alignment; in older children, the femur contributes the most. Based on our results, we recommend monitoring patient limb alignment until it stabilizes around the age of 10, and then carefully planning and performing corrective surgery with complete consideration of the changing bony alignment.

Anterolateral proximal tibial opening wedge osteotomy for biplanar correction in genu valgum recurvatum using patient specific instrumentation (PSI). A technical note.

BACKGROUND: Biplanar anterolateral proximal tibial opening wedge osteotomy has been described as successful for patients with combined recurvatum and valgus alignment. As it is a correction in two planes, it is a technically demanding procedure. We report the use of a novel technique with patient specific instrumentation (PSI) guides for different steps, aiming to reduce the complexity of this procedure. METHODS: One patient was treated for genu valgum recurvatum. A virtual surgical plan was made. A two-step PSI approach was used, consisting of an osteotomy guide and a repositioning guide and a custom trial wedges. RESULTS: Follow-up showed full function and improved VAS and KOOS scores. A neutral alignment was achieved. There was 2.76 degrees less varus compared to pre-operative planning, 1.24 degrees of excess slope and a rotational difference of 0.10 degrees. Saw plane accuracy was within 1 mm. CONCLUSIONS: PSI is a recent technical addition to HTOs as a modality to improve accuracy and reduce surgical complexity. Pre-planning and PSI use in an anterolateral opening wedge PTO allowed for an accurate and reproducible biplanar correction in genu valgum recurvatum. Accuracy was comparable to PSI use in lateral open wedge high tibial osteotomies.

Genu valgum deformity - correction by a wedgeless implantless femoral "V" osteotomy.

Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.

Closing-wedge distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation with genu valgum.

BACKGROUND: Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, despite being a promising procedure for RPD with genu valgum, there is a scarcity of reports on simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO). The purpose of the present study was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum. METHODS: From May 2015 to April 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the anatomical femorotibial angle (aFTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle-trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively. RESULTS: 25 patients, with an average age of 19.8 years (14-27), were evaluated. During the 2-year follow-up period, all patients were able to achieve a better sports level without any problems, with no recurrence of patellar instability. Compared with preoperation, the aFTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance were found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant postoperative improvement. CONCLUSIONS: CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, and can lead to significant improvement in the clinical and imaging findings of the knee in the short term.

Distal femoral osteotomy for genu valgum deformity caused by malunited Hoffa fracture.

Hoffa fractures are unstable intra-articular fractures of the femoral condyle that occur in the coronal plane.Insufficient anatomical reduction and internal fixation may lead to non-union or malunion. A 39-year-old man was involved in a traffic accident while riding a motorcycle and was diagnosed with left Hoffa fracture and avulsion fracture of the femoral attachment of the medial collateral ligament. Open reduction and internal fixation were performed 5 days after injury. The patient experienced intermittent knee pain, joint contracture and deformity, and attended our hospital for further treatment 18 months after surgery. CT revealed depression and malunion of the posterior aspect of the lateral femoral condyle, and weight-bearing X-ray showed valgus deformity due to malunion. Distal femoral osteotomy (DFO) was performed and good functional and radiographic results were obtained. This report suggests that DFO is a reasonable treatment for young patients suffering from malalignment due to malunited Hoffa fracture.

The Association of Gastrocnemius Tightness, Genu Valgum and Hallux Valgus: A Prospective Case-Control Study.

There has been much debate regarding the aetiology and pathogenesis of hallux valgus and it appears to be multifactorial with contracture or tightness of the Achilles tendon and more specifically the gastrocnemius being implicated as an intrinsic factor. The purpose of this study was to look at the association of gastrocnemius tightness, genu valgum and hallux valgus. A prospective case-control study with 25 patients in each group was carried out over a 12-month period. The case group observed adult patients who were referred primarily because of symptomatic hallux valgus and were assessed for the following: hallux valgus stage; presence or absence of isolated gastrocnemius tightness; presence or absence of genu valgum. The control group excluded those with pre-existing hallux valgus, genu valgum and rheumatoid arthritis and were assessed for isolated gastrocnemius tightness. There was a statistically significant association between the presence of genu valgum and hallux valgus when comparing both groups with a p < .001. There was also a statistically significant association between the Silfverskiöld test and the presence of hallux valgus, as well as the Silfverskiöld test and the presence of genu valgum with a p < .001. This study is the first to describe the association of gastrocnemius tightness, genu valgum and hallux valgus. Further studies are required to assess this relationship but knowledge and awareness of it can be applied by clinicians when considering the most appropriate management options with patients.

Linear influence of distal femur osteotomy on the Q-angle: one degree of varization alters the Q-angle by one degree.

PURPOSE: The effect of a distal femur varization osteotomy on patellofemoral biomechanics in genu valgum is unknown. The purpose of this study was to quantify the influence of frontal leg axis correction on the Q-angle with a novel three-dimensional (3-D) measurement method. METHODS: 3-D surface models of ten lower extremities were generated using patient computed tomography (CT) data. The preoperative 3-D Q-angle was measured using a novel defined and validated 3-D measurement method. Biplanar supracondylar osteotomies were simulated with different degrees of varus correction (from 1° to 15°) in one-degree steps beginning from the preoperative valgus deformity, resulting in a total of 150 simulations. Additionally, mechanical leg axis and 3-D Q-angle measurements were performed on 3-D surface models of the postoperative CT scans of the same individuals. Further, pre- and postoperative TT-TG distance was measured. RESULTS: Mean preoperative Q-angle was 15.8 ± 3.9° (range 10°-21.4°) with a mean preoperative mechanical leg axis of 6.5° ± 2.4 valgus (range 3.8°-11.6° valgus). The Q-angle changed linearly 0.9 ± 0° per 1° of varization. No difference was detected between simulated 3-D Q-angles and effectively corrected postoperative values (n.s.). TT-TG distance changed irregularly and minimally, and with no correlation to the degree of varization. CONCLUSION: Distal femur varization osteotomy has a linear effect on the Q-angle with a change of 1° per 1° of varization. The difference in TT-TG distance was mainly due to an unintentional rotational component implemented during surgery.

Middle to long-term results of distal femoral tension band hemiepiphysiodesis in the treatment of idiopathic genu valgum.

Idiopathic genu valgum is a common deformity in children. Guided growth is the treatment of choice in severe or symptomatic cases, although long-term results are mostly unknown. The purpose of this study was to determine the middle- to long-term results and complications of tension band plating in the treatment of idiopathic genu valgum, and the association between obesity and idiopathic genu valgum. A retrospective review of patients with idiopathic genu valgum treated by tension band plating between January 2007 and September 2017 was performed. Data from 99 patients (198 limbs) were reviewed. All underwent bilateral medial distal femoral tension band plating and subsequent plate removal and were followed by a mean of 56.1 months (12-120 months) after surgery. Full correction was achieved in all patients, with a mean correction rate of 0.52° per month. No cases of infection or premature physeal closure were recorded. Screw breakage at the time of removal occurred in five limbs (2.5%). Fifteen limbs (7.5%) developed a minor overcorrection. 44.4% of our patients were either overweight or obese, which is higher than the national average. A third of our patients complained of an unsightly scar at the latest follow-up. Tension band plating is an effective, well tolerated, and reproducible technique in the treatment of idiopathic genu valgum. The risk of premature physeal closure is minimal. We recommend achieving a minor overcorrection before plate removal in patients with more than a year of expected growth. Also, predicting correction based on the mean correction rate is discouraged.

The Prevalence of Genu Varum and Genu Valgum in Overweight and Obese Patients: Assessing the Relationship between Body Mass Index and Knee Angular Deformities.

BACKGROUND: Recent studies have shown evidence of a relationship between overweight and obesity with skeletal abnormalities, especially angular knee disorders. AIM OF THE STUDY: To reveal causal relationship between obesity and skeletal abnormalities. METHODS: This study was performed on 280 overweight or obese patients (with BMI > 25kg/m2) who referred to Rasoul Akram hospital in Tehran between 2017 and 2018. Several non-radiographic methods including measuring Q angle, inter-malleoli distance and distance between two knees were used to determine genu varum and genu valgum.  BMI was also calculated by dividing the weight by the square of the height. RESULTS: The prevalence of genu varumand genu valgum was 8.6% and 10.0% respectively. There was a significant adverse correlation between the Q angle and BMI. The mean BMI in patients with and without genu varum was 39.07 ± 6.41 kg/m2 and 42.1 ± 2.26 kg/m2, respectively, which was significantly lower in the genuvarum group (P = 0.008). Also, the mean BMI in patients with and without genu valgum was 43.39 ± 3.33 kg/m2 and 41.58 ± 4.61  kg/m2, respectively, which was significantly higher in the genuvalgum group (P = 0.044). Also, there was a direct correlation between BMI of patients with inter-malleoli distance and inverse correlation between BMI and two knees distance. CONCLUSION: There is a strong and significant relationship between incidence of obesity and genu valgum; therefore, the prevalence of this deformity in obese individuals is predictable. Also, the lower incidence of genu varum in obese people is predictable in our society.

What is the relationship between the "Fujisawa point" and postoperative knee valgus angle? A theoretical, computer-based study.

BACKGROUND: The purpose of this study was to determine the relationship between the Fujisawa point and postoperative knee valgus angle and the anatomical factors influencing this relationship. METHODS: An experimental study was conducted including 116 patients with medial compartment knee osteoarthritis undergoing treatment with open-wedge high tibial osteotomy (OWHTO). Each patient received simulated HTO through the Fujisawa point in the picture archiving and communication system (PACS). The preoperative hip-knee-ankle (HKA) angle and lower extremity anatomical parameters were recorded before the computerized HTO simulation. The postoperative knee valgus angle was measured after this procedure. A second simulation HTO was performed to adjust the mechanical axis to the optimal valgus angle (4.5°) and calculate the percentage of the tibial plateau width where the Mikulicz line crossed the knee. The Spearman correlation test and multivariate regression were used for analysis. RESULTS: The median preoperative HKA varus angle of this study cohort was 174.1° (170.8, 176.2°). The median knee valgus angle after simulated osteotomy through the Fujisawa point was 2.4° (2.1, 2.7°). The valgus angle was positively correlated with the tibial plateau width (r = 0.23, p = .013) and preoperative HKA angle (r = 0.32, p < .001). Multivariate regression analysis showed that the preoperative HKA angle was a significant contributor to the postoperative valgus angle. When conducting the osteotomy with the optimal valgus angle (4.5°), the percentage of the Mikulicz line passing through the tibial plateau was 71.93% (67-78%). CONCLUSIONS: The preoperative HKA angle affects the postoperative valgus angle after HTO. If the optimal valgus angle of 4.5° is desired, a more lateral position of the Fujisawa point should be targeted during OWHTO, which accounts for approximately 71.9% of the tibial plateau.

Total Knee Arthroplasty for Fixed Valgus Deformity Correction Using a Modified Lateral Parapatellar Approach.

Total knee arthroplasty (TKA) for patients with valgus deformity (> 10 degrees) is technically challenging and has produced variable clinical results in terms of deformity correction, instability, and overall outcomes. The lateral parapatellar approach (LPA) is an alternative to the traditional medial parapatellar approach with potential advantages of direct access for release of tight lateral ligamentous structures with preservation of the medial structures, optimized patellar tracking, preserved medial blood supply to the patella, and less use of constrained implants. We present a case series of a single institution's experience with use of a modified LPA using a Z-capsuloplasty for 35 primary TKA cases in 30 patients with osteoarthritis and Ranawat's type-II fixed valgus deformity with attenuation of medial soft tissues. The mean age of patients was 64.8 years (range: 42-78 years). Follow-up duration was a mean of 47.3 months (range: 3-130 months). The patients were assessed pre- and postoperatively using radiographic measurement of the anatomic femorotibial angle (FTA) and clinical measurement of range of motion (ROM) and the Chinese knee society score (KSS). Complications and reoperations were recorded. The mean coronal alignment was corrected from 20.4 degrees of valgus (range: 11.3-42 degrees) preoperatively to 7.0 degrees of valgus (range: 3.6-15.1 degrees) postoperatively. One case required use of a constrained condylar design implant. At a mean of 47.3 months, the mean Knee Society objective and functional scores improved to 91.8 ± 6.6 and 84.3 ± 18.2 points, respectively. Mean ROM was 94.9 degrees preoperatively and 105.7 degrees postoperatively. Three cases (8.6%) had postoperative complications, including transient common peroneal nerve palsy, hematoma, and deep infection. One patient underwent two-stage revision for infection. There were no cases of late instability. The modified LPA using a Z-capsuloplasty is a reproducible and effective surgical technique for performing TKA in the setting of osteoarthritis and severe valgus deformity.