Total Knee Arthroplasty for Complex Osteoarthritic Varus Knee Deformities

Abstract

Late presentation of osteoarthritic patients led to the evolution of the problem of complex knee deformities. These are cases of bi or multi-planar deformities with associated stiff or loose knees. Associated deformities can be flexion, recurvatum, internal or external tibial torsion. The commonest combination was varus, flexion and internal tibial torsion with deformities mostly intra-articular. So simultaneous correction of these deformities was found to be challenging where restoring limb alignment, gap balancing while obtaining adequate range of motion had to encounter many problems. Measured resection technique with balancing the extension gap first showed excellent results, resecting less bone and preserving bone stock for further revisions. Throughout this study many controversies were tried to be solved through applying cutting edge techniques despite the scarcity of equipment. Old concepts as regarding the subvastal approach were changed as this approach showed to be applicable in obese patients with severe deformities with excellent results as regarding early rehabilitation and achieving target range of motion. Pre-operative planning, adequate bone resection and sequential release of medial structures yielded adequate gap balancing in flexion and extension.