Total Knee Arthroplasty in Valgus Knees

One hundred thirty-four total knee arthroplasties in 98 patients with a valgus alignment were analyzed. Knees with a preoperative alignment of 10° or greater anatomic valgus were believed suitable for inclusion. The average follow-up period in these patients was 4.5 years (range, two to ten years). One hundred eighteen knees were implanted with a posterior stabilized prosthesis, eight knees with a constrained implant design, four knees with a total condylar prosthesis, and four knees with a cruciate-retaining design. All components in all knees were cemented. A lateral retinacular release was necessary in 76% of the arthroplasties secondary to intraoperative lateral subluxation of the patella. The ligamentous release for balancing these valgus-deformed knees was done from the femur. There were 95 knees (71%) rated as excellent, 27 knees (20%) as good, eight knees (6%) as fair, and four knees (3%) as poor. Postoperatively, 76% of the knees had a tibiofemoral alignment between 5° and 9° valgus with an overall average of 7° valgus (range, 3° varus to 15° valgus). Total knee arthroplasty is a reliable and durable procedure in the treatment of valgus knee arthritis. However, valgus-deformed knees represent a greater challenge than their varus counterparts to the implant surgeon in terms of the intraoperative balancing required. This may be a function of the greater difficulty in achieving ligamentous equilibrium and the relative rarity of valgus-deformed knees.