Complex Primary Total Knee Arthroplasty: Management of Extra-articular Deformity

Abstract

A 70-year-old female who sustained an osteoporotic proximal tibia fracture approximately 5 years prior to presentation. This was treated with an ORIF that failed and fixation was revised with an intramedullary nail. The fracture healed with a varus malunion. She subsequently developed posttraumatic arthritis of her left knee. She has failed comprehensive conservative management of her knee arthritis. Diagnosis/AssessmentPhysical exam revealed an antalgic gait favoring the left side, with a mild varus thrust. There was minimal visible varus deformity of the tibia but the patient had an overall varus alignment of bilateral lower extremities, left much greater than the right. She had a well-healed midline incision over

Total Knee Arthroplasty in Patients with Distal Femoral Malunion: A Case Report

“…We found careful preoperative planning and measurement is the key to dealing with extra-articular deformity and arthritis of the knee is preoperative planning. 6 Moreover, bowing of the femur or tibia as well as previous fractures that may have gone unnoticed since childhood can be identified on the scanogram and thus should always be done to guide and ensure recreation of mechanical axis. The closer the deformity is to the joint, the greater impact the deformity has on the orientation of resection thus the farther deformity from the knee joint may be less in need of corrective osteotomy than those that are closer to the knee joint.…”