Total Knee Replacement with Associated Extra-Articular Angular Deformity of the Femur

Conclusion

Review of the literature certainly does not reveal the most appropriate method for performing total knee arthroplasty in patients with extra-articular angular deformities due to the relative infrequency of this clinical problem. The primary goal of the surgeon should be attaining appropriate mechanical alignment in these difficult cases. The advantages of correction of the angular deformity at the joint line are the avoidance of an additional operative procedure for osteotomy and the risk of nonunion. Thorough preoperative planning is essential and deformity correction by osteotomy prior to arthroplasty should be performed in all femoral deformities that require bony resection above the level of the epicondyles for realignment of the mechanical axis. Attention to detail at the time of surgery should ensure that the bone resection of the distal femur and proximal tibial are perpendicular to the floor for correction of the mechanical axis and to prevent obliquity of the joint line. Posterior cruciatesacrifice and the understanding of appropriate soft tissue releases is mandatory for deformity correction using this method.