Current surgical strategies for total arthroplasty in valgus knee

Abstract

The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees.

Strain Assessment of Deep Fascia of the Thigh During Leg Movement: An in situ Study

“…Groups based on knee range of motion, or varus-valgus could also be studied, and the focus on a specific leg pathology or surgical practice could be considered. For instance, a surgical technique, at the knee level, that could benefit this work is the "pie-crusting" technique (Clarke et al, 2005;Nikolopoulos et al, 2015). Patients with varus or valgus knee may need this technique that consists of tissue release, and that can be done on ITT.…”

Primary Total Knee Arthroplasty in Valgus Deformity

“…The orthopedic surgeon should also observe the posterior capsule's presence of osteophytes, on the knee X-ray lateral view. Lastly, the lateral view can be further used for sizing the femoral component and for locating the entry point of the femoral canal [1,11,17].…”

“…In order to understand and perform the valgus knee operative procedure, the orthopedic surgeons should consider that the lateral stabilizers are of two types: (1) the lateral collateral ligament (LCL) and the popliteal tendon who insert near the flexion-extension axis and act in both knee extension and flexion and (2) the fascia lata, the posterolateral articular capsule (PLC), the biceps and the external gastrocnemius muscles who insert remotely with respect to the axis and act only in extension [17,25].…”

“…In the anterolateral approach, as described in detail by Nikolopoulos et al [4,17], a straight midline skin incision is followed by a lateral parapatellar capsulotomy. The ITB is next elevated from Gerdy's tubercle.…”

“…Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue and gap balance [17]. Over the last 20 years, numerous approaches and soft-tissue procedures have been proposed to perform TKA in VD with the purpose to restore and maintain the limb's anatomical axis.…”