Extra-Articular Deformity

  • Arun B. Mullaji
  • Gautam M. Shetty


In most total knee arthroplasties (TKAs) for arthritic knees with intra-articular varus or valgus deformity, both alignment and ligament balance can be achieved with appropriate bone cuts and soft-tissue releases. However, TKA becomes technically challenging when knee arthritis is associated with an extra-articular deformity (EAD) of either the femur or the tibia. Such deformities are commonly caused secondary to trauma (malunion or non-union), previous osteotomy, metabolic causes such as osteomalacia or osteoporosis causing excessive bowing or stress fractures and congenital causes (Fig. 8.1). Stress fracture although uncommon is a frequent cause of tibial EAD in patients with knee arthritis.


Arthritis Osteoporosis Osteoarthritis Tray Versed 


  1. 1.
    Mullaji A, Shetty GM. Computer-assisted total knee arthroplasty for arthritis with extra-articular deformity. J Arthroplasty. 2009;24:1164–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Mullaji A, Shetty G. Total knee arthroplasty for arthritic knees with tibiofibular stress fractures classification and treatment guidelines. J Arthroplasty. 2010;25:295–301.PubMedCrossRefGoogle Scholar
  3. 3.
    Wang JW, Wang CJ. Total knee arthroplasty for arthritis of the knee with extra-articular deformity. J Bone Joint Surg Am. 2002;84:1769–74.PubMedCrossRefGoogle Scholar
  4. 4.
    Fehring TK, Mason JB, Moskal J, Pollock DC, Mann J, Williams VJ. When computer-assisted knee replacement is the best alternative. Clin Orthop Relat Res. 2006;452:132–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Chou WY, Ko JY, Wang CJ, Wang FS, Wu RW, Wong T. Navigation-assisted total knee arthroplasty for a knee with malunion of the distal femur. J Arthroplasty. 2008;23:1239.e13–9.CrossRefGoogle Scholar
  6. 6.
    Klein GR, Austin MS, Smith EB, Hozack WJ. Total knee arthroplasty using computer-assisted navigation in patients with deformities of the femur and tibia. J Arthroplasty. 2006;21:284–8.PubMedCrossRefGoogle Scholar
  7. 7.
    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;23:74–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Kim KI, Ramteke AA, Bae DK. Navigation-assisted minimal invasive total knee arthroplasty in patients with extra-articular femoral deformity. J Arthroplasty. 2009;25:658.e17–22.Google Scholar
  9. 9.
    Mullaji AB, Shetty GM. Lateral epicondylar osteotomy using computer navigation in total knee arthroplasty for rigid valgus deformities. J Arthroplasty. 2010;25:166–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Mullaji AB, Shetty GM. Surgical technique: computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA. Clin Orthop Relat Res. 2013;471:1484–91.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Mullaji AB, Marawar SV, Mittal V. A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplasty. 2009;24:861–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Bonnin M, Zayni R. Total knee arthroplasty after failed high tibial osteotomy. In: Bonnin M, Amendola NA, Bellemans J, MacDonald SJ, Menetrey J, editors. The knee joint. Paris: Springer; 2012. p. 923–32.CrossRefGoogle Scholar
  13. 13.
    Madan S, Ranjith RK, Fiddian NJ. Total knee replacement following high tibial osteotomy. Bull Hosp Jt Dis. 2002–2003;61:5–10.Google Scholar
  14. 14.
    Mullaji AB, Shetty GM, Kanna R, Vadapalli RC. The influence of preoperative deformity on valgus correction angle: an analysis of 503 total knee arthroplasties. J Arthroplasty. 2013;28:20–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Mullaji A, Kanna R, Marawar S, Kohli A, Sharma A. Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees. J Arthroplasty. 2007;22:953–9.PubMedCrossRefGoogle Scholar
  16. 16.
    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;20:550–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Mullaji AB, Shetty GM. Correction of varus deformity during TKA with reduction osteotomy. Clin Orthop Relat Res. 2014;472:126–32.Google Scholar
  18. 18.
    Mason JB, Fehring TK. Management of extra-articular deformity in total knee arthroplasty with navigation. In: Scott WN, editor. Insall & scott surgery of the knee. Philadelphia: Elsevier Churchill Livingstone; 2012. p. 1234.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Arun B. Mullaji
    • 1
  • Gautam M. Shetty
    • 2
  1. 1.Consultant Joint Replacement Surgeon Department of Orthopaedic SurgeryBreach Candy HospitalMumbaiIndia
  2. 2.Consultant Arthritis Care and Joint Replacement SurgeryAsian Orthopedic Institute Asian Heart Institute and Research CenterMumbaiIndia

Personalised recommendations