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Lateral Release for Fixed-Valgus Deformity

  • Frankie M. Griffin
  • Giles R. Scuderi
  • John N. Insall

Summary

Fixed-valgus deformity can be a challenging problem for the reconstructive surgeon. The normal knee is aligned with a femorotibial angle of 6 to 7 degrees of valgus, and the goals of knee replacement surgery include a painfree knee with normal alignment and functional range of motion. We believe a posterior-stabilized prosthesis with sacrifice of the PCL will provide more reliable results for most surgeons in the valgus knee. The surgical epicondylar axis provides a reliable and reproducible landmark for appropriate rotational alignment of the femoral component, whereas the less involved medial femoral condyle and tibial plateau should be used to reference the distal femoral and proximal tibial cuts. Soft tissue balance should be achieved without modification of bone cuts. Sequential releases should be reassessed intermittently with laminar spreaders or a tensor. Avariety of releases and sequences of release have been described, and our preferred method is described earlier in this chapter. Correctly balanced, 90 to 95% of patients with valgus deformity reportedly will have good or excellent results. Complications include peroneal nerve palsy, instability, and patellar maltracking.

Keywords

Total Knee Arthroplasty Femoral Component Peroneal Nerve Lateral Release Valgus Deformity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Insall JN. Surgery of the Knee. 2nd ed.Google Scholar
  2. 2.
    Watanabe Y, Moriya H, Takahashi K, Yamagata M, Sonoda M, Shimada Y, Tamake T. Functional anatomy of the posterolateral structures of the knee. Arthroscopy. 1993; 9:57–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Whiteside LA. Correction of ligament and bone defects in total arthroplasty of the severely valgus knee. Clin Orthop. 1993; 288:234–245.PubMedGoogle Scholar
  4. 4.
    Colizza WA, Insall JN. The posterior stabilized total knee prosthesis. J Bone Joint Surg. 1995; 77A(11):1713–1720.Google Scholar
  5. 5.
    Krackow KA. The Technique of Total Knee Arthroplasty. St. Louis: The C.V. Mosby Company; 1990.Google Scholar
  6. 6.
    Laurencin CT, Scott RD, Volatile TB, Gebhardt EM. Total knee replacement in severe valgus deformity. The American Journal of Knee Surgery. Summer 1992; 5(3):135–139.Google Scholar
  7. 7.
    Bullek DD, Scuderi GR, Insall JN. The constrained condylar knee prosthesis: an alternative for the valgus knee in the elderly. In: Insall JN, Scott WN, Scuderi GR, eds. Current Concepts in Primary and Revision Total Knee Arthroplasty. Philadelphia: Lippincott-Raven Publishers; 1996.Google Scholar
  8. 8.
    Stern SH, Moekel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop. 1991; 273:5–8.PubMedGoogle Scholar
  9. 9.
    Scuderi GR, Insall JN. Fixed varus and valgus deformities. Master Techniques in Orthopaedic Surgery, Knee Arthroplasty. Lotke PA, ed. New York: Raven Press, Ltd; 1995.Google Scholar
  10. 10.
    Keblish PA. The lateral approach to the valgus knee: surgical technique and analysis of 53 cases with two-year follow-up evaluation. Clin Orthop. 1991; 271:52–62.PubMedGoogle Scholar
  11. 11.
    Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop. 1993; 286:40–47.PubMedGoogle Scholar
  12. 12.
    Scuderi GR, Insall JN. The posterior stabilized prosthesis. Orthop Clinics North America. 1989; 20(1):71–78.Google Scholar
  13. 13.
    Buechel FF. A sequential three-step lateral release for correcting fixed valgus knee deformities during total knee arthroplasty. Clin Orthop. 1990; 280:170–175.Google Scholar
  14. 14.
    Clayton ML, Thompson TR, Mack RP. Correction of alignment deformities during total knee arthroplasties: staged soft-tissue releases. Clin Orthop. 1986; 202:117–124.PubMedGoogle Scholar
  15. 15.
    Dorr LD, Boiardo RA. Technical considerations in total knee arthroplasty. Clin Orthop. 1986; 205:5–11.PubMedGoogle Scholar
  16. 16.
    Freeman MAR, Sculco T, Todd RC. Replacement of the severely damaged arthritic knee by the ICLH (Freeman-Swanson) arthroplasty. J Bone Joint Surg. 1977; 59B(1):64–71.Google Scholar
  17. 17.
    Insall JN. Modified technique of lateral release for valgus deformity. Personal communication.Google Scholar
  18. 18.
    Insall JN. TKA valgus deformity. Personal communication.Google Scholar
  19. 19.
    Insall JN, Scott WN, Ranawat CS. The total condylar knee prosthesis. J Bone Joint Surg. 1979; 61A(2):173–180.Google Scholar
  20. 20.
    Krackow KA, Jones MM, Teeny SM, Hungerford DS. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop. 1991; 273:9–18.PubMedGoogle Scholar
  21. 21.
    Ranawat CS. Total-condylar knee arthroplasty for valgus and combined valgus-flexion deformity of the knee. Techniques Orthop. 1988; 3(2):67–75.CrossRefGoogle Scholar
  22. 22.
    Idusuyi OB, Morrey BF. Personeal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg. 1996; 78A(2):177–184.Google Scholar
  23. 23.
    Asp JP, Rand JA. Peroneal nerve palsy after total knee arthroplasty. Clin Orthop. 1990; 261:233–237.PubMedGoogle Scholar
  24. 24.
    Krackow KA, Maar DC, Mont MA, Carroll C. Surgical decompression for peroneal nerve palsy after total knee arthroplasty. Clin Orthop. 1993; 292:223–228.PubMedGoogle Scholar
  25. 25.
    Insall JN, Lachiewicz PF, Burnstein AH. The posterior stabilized condylar prosthesis: a modification of the total condylar design. J Bone Joint Surg. 1982; 64A:1317.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Frankie M. Griffin
    • 1
  • Giles R. Scuderi
    • 2
    • 3
    • 4
  • John N. Insall
    • 3
    • 4
  1. 1.The Insall Scott Kelly InstituteOrthopedic SurgeonVan BuranUSA
  2. 2.Lenox Hill HospitalNew YorkUSA
  3. 3.The Insall Scott Kelly InstituteNew YorkUSA
  4. 4.Albert Einstein College of MedicineBronxUSA

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