Total Knee Arthroplasty for Profound Varus Deformity

One hundred seventy-three knees in 117 patients with varus deformity exceeding 20° were prospectively evaluated. Using selective posteromedial release, reduction osteotomy of posteromedial tibial flare, and extra-articular tibial osteotomy, with the preservation of medial collateral ligament integrity, mean tibiofemoral angle of 22.7° varus preoperatively (range, 15°-62°) was corrected to 5.3° valgus (range, 2°-9°) postoperatively. Eighty-six percent of the knees were in 4° to 10° valgus postoperatively. Mean Knee Society score improved from 22.8 (range, 0-64) to 91.1 (range, 52-99), and function score from 22.8 (range, 0-64) to 72.1 (range, 5-100) at 2.6 years (range, 2-9 years). Mean femoral component valgus was 95.5° (range, 92°-98°), and mean tibial component valgus was 89.8° (range, 86°-94°). Of 30 grafts for posteromedial tibial defects, 28 were successfully incorporated. No patient reported significant instability. Three knees (1.7%) showed tibial component loosening with recurrence of deformity. Correction of severe varus deformity by the technique reported can successfully restore alignment, pain-free motion, and stability.