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Total knee arthroplasty using a pie-crusting technique for valgus deformity.
Paolo Aglietti1, Domenico Lup, Pierluigi Cuomo
1First Orthopaedic Clinic, University of Florence, Florence, Italy. ortosec@unifi.it
Clinical Orthopaedics and Related Research
|November 3, 2007
Summary
The pie-crusting technique effectively corrects valgus deformities during total knee arthroplasty (TKA). This method achieved good alignment and function with a low complication rate in a mid-term follow-up study.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
Background:
- Correcting valgus deformity in total knee arthroplasty (TKA) presents significant challenges.
- Extensive lateral soft tissue releases can lead to complications like lateral condyle avascularity and instability.
Purpose of the Study:
- To evaluate the efficacy of the pie-crusting technique for selective lateral soft tissue release in TKA for valgus deformity.
- To assess the technique's ability to correct frontal plane deformity, improve patellar tracking, and minimize complications.
Main Methods:
- A case series of 48 patients (53 knees) with valgus deformities undergoing TKA.
- Selective lateral soft tissue balancing using the pie-crusting technique, with lateral retinaculum release for patellar maltracking.
- Follow-up for a minimum of 5 years (mean 8 years).
Main Results:
- Achieved alignment within 5 degrees of neutral in 96% of knees (51/53).
- One transient postoperative peroneal nerve palsy (recovered fully); no component revisions.
- Low complication rate with preservation of the popliteus tendon, reducing posterolateral instability risk.
Conclusions:
- The pie-crusting technique reliably corrects moderate to severe fixed valgus deformities in TKA.
- This method offers a low complication rate and reasonable mid-term functional outcomes.
- Gradual stretching of lateral tissues and preservation of key structures contribute to successful outcomes.