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Lateral Epicondylar Sliding Osteotomy in Total Knee Arthroplasty for Rigid Valgus Deformity

February 19, 2016

Contributors: Cosma Calderaro, MD; Daniele Mazza, MD; Gabriele Bolle; Andrea Redler, MD; Raffaele Iorio, MD; Andrea Ferretti, MD; Fabio Conteduca, MD; Fabio Conteduca, MD

Valgus knees are defined as those with a valgus alignment of the mechanical axis major of 10 degrees on standing anteroposterior radiographs. Severe valgus deformities are associated with a worse outcome and more difficult surgery when compared with their varus counterparts. Current surgical techniques correct alignment, gap balancing, and rotation of the components in valgus knees by releasing the lateral soft tissue structures such as iliotibial band, posterolateral capsule, popliteus tendon, and hamstring tendons. However, in cases with severe or rigid valgus deformity, these releases excessively disrupt and do not adequately balance the soft tissues and may lead to postoperative overcorrection and mediolateral instability. In order to prevent such instability and to use a less invasive treatment over the external compartment ligaments of the arthritic valgus knee, a balancing technique using a sliding osteotomy of the lateral aspect of the lateral femoral condyle, as described by Brilhault, allows precise lengthening of the lateral structures, while the internal fixation by screws gives immediate stability and allows normal postoperative care.In this video we used a tibial-first uncemented mobile bearing prosthesis to prove the effectiveness of this procedure. The knee is exposed using a lateral parapatellar arthrotomy. A total of five patients (4 women, 1 man), mean aged 74 years (range 70 to 81 years) at the time of surgery, with fixed valgus deformities, underwent sliding osteotomy of the lateral femoral condyle as described. At a minimun follow up of two years, they were clinically and radiologically evaluated. All were successfull and no major complications were recorded. The postoperative Knee Society Score was 89 points (85-98 points), while the postoperative Function Score was 90 points (78 to 99 points) postoperatively. The preoperative valgus angle was 17° (range 16° to 22°), postoperative 2° (0° to 3°). No conversion to a semi-constrained or constrained knee prosthesis was necessary. The lateral femoral sliding osteotomy technique for ligamentous balancing is a reliable and effective surgical procedure in restoring stable alignment in patients with a rigid valgus knee deformity, reducing the need of lateral soft tissue release and the use of semi-constrained or constrained knee prosthesis.

Results for "Primary Knee Arthroplasty"

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