Ligament release and bone grafting in total arthroplasty of the varus knee

AbstractA simplified technique is described for restoring joint line position, correcting bony defects, and achieving ligament balance in the varus knee. The thickness of the Implant is resected based on the intact surface at a predetermined 5° or 7° valgus angle. Resulting medial femoral and tibial defects are grafted with morselized cancellous autograft, and the medial ligaments are released from the tibial surface to achieve appropriate matching of varus/valgus stability. Four hundred twenty-three knees with varus deformity of 5° to 55° were followed for 2 to 7 years after surgery. Of the 98 knees with moderate varus deformity, two had grafting of minor tibial defects and none had femoral grafting. Of the 36 with severe varus deformity, three had grafting of the femoral condyle distal surface and 26 had medial tibial plateau grafting. Mean valgus angle 1 year after surgery was 5.3°, and yearly follow up revealed no tendency for deterioration of alignment Bone graft collapse was not found in any knee. Radiographic analysis of the tibial grafts routinely demonstrated trabeculation of the graft 2 years postoperatively. Mean postoperative range of motion was 111° 1 year after surgery and 115° 2 years after surgery. No major complications were found as a result ofeither bone grafting or ligament release. This simplified technique of resection of the bone surfaces to match the thickness of the implant is safe and effective in the severely deformed varus knee.