Valgus deformity in total knee replacement is a much lesser encountered problem than varus deformity. The deformity can be caused by either bony or ligamentous pathology or both. Bone defects like lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodeling along with soft tissue pathologies like tight lateral collateral ligament (LCL), posterolateral capsule (PLC), popliteus tendon (POP), hamstring tendons, the lateral head of the gastrocnemius (LHG) and iliotibial band (ITB) can add to the magnitude of valgus deformity. Various sequences have been described to achieve balancing while doing a total knee replacement. Proper preoperative planning, clinical examination, necessary implant backup and good operative skill are mandatory to manage bone deformities or soft tissue pathology or both in valgus deformity. Obtaining an accurate axis restoration, component orientation and joint stability in a valgus knee with combined bony and ligamentous pathology may be a difficult task. The long-term results in valgus knees are relatively inferior to those with varus deformity. This chapter structure wise describes the pathology, classification of valgus deformity, radiographic planning, surgical approaches, method of valgus deformity correction, implant selection, associated deformities, precautions and intraoperative complications.