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
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.