Valgus knee deserves personalized total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering

Background:

• Valgus knees constitute 18.5% of total knee arthroplasty (TKA) cases.
• Conventional mechanical alignment (MA) TKA presents challenges in valgus knees, potentially causing femoral condyle issues and instability.
• Misconceptions about valgus knee anatomy and biomechanics have limited personalized arthroplasty adoption for these cases.

Purpose of the Study:

• To evaluate the efficacy and outcomes of personalized arthroplasty techniques in valgus knees.
• To address challenges associated with TKA in valgus knees and compare them to varus knees.
• To highlight advancements in implant survivorship and patient satisfaction for valgus TKA.

Main Methods:

• Review of joint laxity assessment in valgus knees, including medial collateral ligament (MCL) laxity.
• Surgical technique modifications for patellar tracking and medial compartment gap management.
• Adaptations for pathological patellofemoral joints, such as trochlear modifications and lateral retinacular release.

Main Results:

• Careful joint laxity assessment guides surgical decisions, from tibial undercutting to soft tissue releases or constrained implants.
• Personalized surgical approaches can effectively manage patellar tracking and joint instability in valgus knees.
• Long-term studies demonstrate high patient satisfaction and outcomes comparable to varus knees with restricted kinematic alignment TKA.

Conclusions:

• Total knee arthroplasty in valgus knees can achieve high patient satisfaction and comparable outcomes to varus knees.
• Personalized surgical strategies and meticulous joint laxity management are crucial for successful valgus TKA.
• Overcoming historical challenges requires updated understanding of valgus knee biomechanics and modern implant advancements.