Varus malalignment is the most common deformity leading to total knee arthroplasty (TKA) for knee arthritis. For correcting this deformity, a stepwise approach is used by surgeons during TKA. When a severe varus malalignment is present, there are some concerns regarding balancing procedure, meaning that aggressive release of medial structures could lead to instability and need for a more constrained implant. In this chapter, the results of an unconventional method for balancing severe varus malalignment are shown. This method is medial epicondyle osteotomy (MEO). For this reason, a total of 135 knees with severe varus deformity were studied. In 65 cases, the MEO technique was used for balancing during TKA. The other 70 cases were balanced using additional resection of medial tibial plateau. Clinical and radiological outcomes were measured before and after surgery for both groups. Also the results were compared to a control group consisting of 50 patients with TKA for varus deformity less than 15 degrees. The amount of resected tibial bone was noted for study groups. Range of motion, the Knee Society Score (KSS), frontal laxity, and correction of femoro-tibial angle were studied. Frontal laxity decreased from 12.81° ± 3.9° to 0.37° ± 1.2° (P < 0.001). The results showed no statistically significant differences between groups regarding the KSS, range of motion, femoro-tibial angle, and frontal laxity. The amount of resected tibial bone and the mean thickness of the polyethylene insert were statistically significantly smaller in the MEO group. MEO technique could be useful when treating severe varus arthritis knee during TKA by avoiding aggressive medial release and malalignment. Also the bone stock is preserved.
Part of the book: Knee Surgery