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Total Knee Arthroplasty for Severe Valgus DeformityFIVE TO FOURTEEN-YEAR FOLLOW-UP
Mark Elkus, MD1; Chitranjan S. Ranawat, MD1; Vijay J. Rasquinha, MD1; Sushrut Babhulkar, MD1; Roberto Rossi, MD1; Amar S. Ranawat, MD1
1 Department of Orthopedic Surgery, Lenox Hill Hospital, 130 East 77th Street, William Black Hall 11th Floor, New York, NY 10021. E-mail address for A.S. Ranawat: aranawat@rocinnyc.com
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (C.S. Ranawat is a consultant for DePuy). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Dec 01;86(12):2671-2676
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Background: In 1985, the senior author (C.S.R.) developed a new soft-tissue release technique to balance valgus knees to avoid unacceptably high rates of late-onset instability and the need for primary constrained implants. This report describes the soft-tissue release technique and its long-term results when performed in primary total knee arthroplasty in patients with a severe valgus knee deformity.

Methods: Four hundred and ninety consecutive total knee arthroplasties were performed by one surgeon between January 1988 and December 1992. In this group, seventy-one patients (eighty-five knees) had a valgus deformity of =10°. Thirty-two patients (thirty-six knees) died, and four patients (seven knees) were lost to follow-up, leaving thirty-five patients (forty-two knees) followed for a minimum of five years. These twenty-seven women and eight men had a mean age of sixty-seven years at the time of the index operation. The technique included an inside-out soft-tissue release of the posterolateral aspect of the capsule with pie-crusting of the iliotibial band and resection of the proximal part of the tibia and distal part of the femur to provide a balanced, rectangular space. Cemented, posterior stabilized implants were used in all knees. Clinical and radiographic evaluations were performed at one, five, and ten years postoperatively.

Results: The mean modified Knee Society clinical score improved from 30 points preoperatively to 93 points postoperatively, and the mean functional score improved from 34 to 81 points. The mean range of motion was 110° both preoperatively and postoperatively. The mean coronal alignment was corrected from 15° of valgus preoperatively to 5° of valgus postoperatively. Three patients underwent revision surgery because of delayed infection, premature polyethylene wear, and patellar loosening in one patient each. There were no cases of delayed instability.

Conclusions: The inside-out release technique to correct a fixed valgus deformity in patients undergoing primary total knee arthroplasty is reproducible and provides excellent long-term results.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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