Correction of Severe Deformity in Total Knee Arthroplasty: Decision Making and Key Technical Considerations

Treating complex arthritic knee deformities with hinged total knee arthroplasty may be technically simpler but involves issues of higher cost, uncertain long-term implant survival, particularly in younger and active patients. Using a graduated, step-wise intra-articular correction technique with or without an osteotomy performed concomitantly during total knee arthroplasty allows the surgeon to achieve a well-balanced and well-aligned knee. Full correction of knee deformity and optimum soft-tissue balance can be achieved in the vast majority of arthritic knees with complex deformities using the patient's own soft-tissue envelope and without resorting to use of hinged implants.