Skip to main content

Management of Extra-articular Deformity

  • Chapter
  • First Online:
Complex Cases in Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) in the presence of severe extra-articular deformity remains a challenging situation. Such deformities mainly occurring secondary to femoral or tibial fracture malunion, failed osteotomy, prior physeal injury, congenital deformity, metabolic bone disease, and skeletal dysplasia. In these situations, the standard principles of TKA still apply, including restoration of the mechanical alignment and soft tissue balance. The challenge relates to the implications of the distal femoral and proximal tibial bone resection in both the coronal and sagittal planes. The extra-articular deformity must in some way be corrected by the bone resection. There are several options for correction of the deformity; one is arthroplasty with intra-articular correction, or combined with an extra-articular corrective osteotomy, either as a staged or simultaneous procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 179.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 229.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 239.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wolff AM, Hungerford DS, Pepe CL. The effect of extraarticular varus and valgus deformity on total knee arthroplasty. Clin Orthop Relat Res. 1991;(271):35–51.

    Google Scholar 

  2. Wang JW, Wang CJ. Total knee arthroplasty for arthritis of the knee with extraarticular deformity. J Bone Joint Surg Am. 2002;84-A(10):1769–74.

    Article  PubMed  Google Scholar 

  3. Mullaji A, Shetty GM. Computer assisted total knee arthroplasty for arthritis with extra-articular deformity. J Arthoplasty. 2009;24(8):1164–9.

    Article  Google Scholar 

  4. Koenig JH, Maheshwari AV, Ranawat AS, Ranawat CS. Extra-articular deformity is always correctable intra-articularly: in the affirmative. Orthopedics. 2009;32(9). https://doi.org/10.3928/01477447-20090728-22.

  5. Hungerford DS. Extra-articular deformity is always correctable intra-articularly: to the contrary. Orthopedics. 2009;32(9):https://doi.org/10.3928/01477447-20090728-23.

  6. Lonner JH, Siliski JM, Lotke PA. Simultaneous femoral osteotomy and total knee arthroplasty for treatment of osteoarthritis associated with severe extra-articular deformity. J Bone Joint Surg Am. 2000;82(3):342–8.

    Article  CAS  PubMed  Google Scholar 

  7. Marczak D, Synder M, Sibinski M, Okon T, Kowalczewski J. One-stage total knee arthroplasty with pre-existing fracture deformity: post-fracture total knee arthroplasty. J Arthroplasty. 2014;29(11):2104–8.

    Article  PubMed  Google Scholar 

  8. Rajgopal A, Vasdev A, Dahiya V, Tyagi VC, Gupta H. Total knee arthroplasty in extra articular deformities: a series of 36 knees. Indian J Orthop. 2013;47(1):35–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tigani D, Masetti G, Sabbioni G, Ben Ayad R, Filanti M, Fosco M. Computer-assisted surgery as indication of choice: total knee arthroplasty in case of retained hardware or extra-articular deformity. Int Orthop. 2012;36(7):1379–85.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rhee SJ, Seo CH, Suh JT. Navigation-assisted total knee arthroplasty for patients with extra-articular deformity. Knee Surg Relat Res. 2013;25(4):194–201.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Thienpont E, Paternostre F, Pietsch M, Hafez M, Howell S. Total knee arthroplasty with patient-specific instruments improves function and restores limb alignment in patients with extra-articular deformity. Knee. 2013;20(6):407–11.

    Article  PubMed  Google Scholar 

  12. Bottros J, Klika AK, Lee HH, Polousky J, Barsoum WK. The use of navigation in total knee arthroplasty for patients with extra-articular deformity. J Arthroplasty. 2008;23(1):74–8.

    Article  PubMed  Google Scholar 

  13. Mullaji A, Shetty GM. Computer-assisted total knee arthroplasty for arthritis with extra-articular deformity. J Arthroplasty. 2009;24(8):1164–9.e1.

    Article  PubMed  Google Scholar 

  14. Rozbruch SR, Kleinman D, Fragomen AT, Ilizarov S. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res. 2008;466(12):2923–32.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gantsoudes GD, Fragomen AT, Rozbruch SR Intraoperative measurement of mounting parameters for the Taylor Spatial Frame. J Orthop Trauma. 2010;24(4):258–62.

    Article  PubMed  Google Scholar 

  16. Rozbruch SR, Fragomen AT, Frame IS. correction of tibial deformity with use of the Ilizarov-Taylor spatial frame. J Bone Joint Surg Am. 2006;88(Suppl 4):156–74.

    PubMed  Google Scholar 

  17. Rozbruch SR, Segal K, Ilizarov S, Fragomen AT, Ilizarov G. Does the Taylor Spatial Frame accurately correct tibial deformities? Clin Orthop Relat Res. 2010;468(5):1352–61.

    Article  PubMed  Google Scholar 

  18. Mullaji AB, Padmanabhan V, Jindal G. Total knee arthroplasty for profound varus deformity: technique and radiological results in 173 knees with varus of more than 20 degrees. J Arthroplasty. 2005;20(5):550–61.

    Article  PubMed  Google Scholar 

  19. Ishida K, Tsumura N, Takayama K, Fukase N, Kitagawa A, Chin T, et al. Thermal necrosis after simultaneous tibial osteotomy and total knee arthroplasty using a press-fit extension stem. Knee Surg Sports Traumatol Arthrosc. 2011;19(1):112–4.

    Article  PubMed  Google Scholar 

  20. Hungerford DS. Extra-articular deformity is always correctable intra-articularly: to the contrary. Orthopedics. 2009;32(9). pii: orthosupersite.com/view.asp?rID=42844. doi: https://doi.org/10.3928/01477447-20090728-23.

  21. Mahoney OM, Clarke HD, Mont MA, McGrath MS, Zywiel MG, Dennis DA, et al. Primary total knee arthroplasty: the impact of technique. J Bone Joint Surg Am. 2009;91(Suppl 5):59–61.

    Article  PubMed  Google Scholar 

  22. McGrath MS, Suda AJ, Bonutti PM, Zywiel MG, Marker DR, Seyler TM, et al. Techniques for managing anatomic variations in primary total knee arthroplasty. Expert Rev Med Devices. 2009;6(1):75–93.

    Article  PubMed  Google Scholar 

  23. Oswald MH, Jakob RP, Schneider E, Hoogewoud HM. Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty. J Arthroplasty. 1993;8(4):419–26.

    Article  CAS  PubMed  Google Scholar 

  24. Haddad FS, Bentley G. Total knee arthroplasty after high tibial osteotomy: a medium-term review. J Arthroplasty. 2000;15(5):597–603.

    Article  CAS  PubMed  Google Scholar 

  25. Berend KR, Lombardi AV Jr. Distal femoral replacement in nontumor cases with severe bone loss and instability. Clin Orthop Relat Res. 2009;467(2):485–92.

    Article  PubMed  Google Scholar 

  26. Shih LY, Sim FH, Pritchard DJ, Rock MG, Chao EY. Segmental total knee arthroplasty after distal femoral resection for tumor. Clin Orthop Relat Res. 1993;(292):269–81.

    Google Scholar 

  27. Morgan H, Battista V, Leopold SS. Constraint in primary total knee arthroplasty. J Am Acad Orthop Surg. 2005;13(8):515–24.

    Article  PubMed  Google Scholar 

  28. Hartford JM, Goodman SB, Schurman DJ, Knoblick G. Complex primary and revision total knee arthroplasty using the condylar constrained prosthesis: an average 5-year follow-up. J Arthroplasty. 1998;13(4):380–7.

    Article  CAS  PubMed  Google Scholar 

  29. Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am. 2007;89(8):1735–41.

    PubMed  Google Scholar 

  30. Wolff AM, Hungerford DS, Pepe CL. The effect of extra articular varus and valgus deformity on total knee arthroplasty. Clin Orthop Relat Res. 1991;(271):35–51.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to S. Robert Rozbruch MD or Michael A. Mont MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Scuderi, G.R. et al. (2018). Management of Extra-articular Deformity. In: Tria, A., Scuderi, G., Cushner, F. (eds) Complex Cases in Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-69380-4_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-69380-4_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-69379-8

  • Online ISBN: 978-3-319-69380-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics