Total Knee Replacement for Severe Valgus Deformity of the Knee

Patients with severe valgus deformity of the knee show changes such as shortening of the iliotibial band, relaxation of medial collateral ligament, and external rotation of the tibia, in addition to presence of bone defects in the lateral femoral condyle and lateral tibial plateau. In conducting total knee replacement (TKR) in such patients, therefore, it is important to fix the knee prosthesis at the correct site and correct the above-mentioned deformities and contracture. The medial collateral ligament, which is most important in securing good support after surgery, is relaxed when ordinary osteotomy is conducted for knees with severe valgus deformity. Various techniques have been proposed to ensure good support by a relaxed medial collateral ligament. We have obtained good results using proximal realignment techniques. This paper describes these techniques and others we use in TKR for knees with severe valgus deformity.