Total knee arthroplasty for valgus deformity correction using "inverted cruciform release": technique and outcomes

Technique of lateral contractures structure release of total knee arthroplasty (TKA) with severe valgus deformity remains difficult and major challenged. We investigated the reliability and clinical outcomes of TKA using the "inverted cruciform release" technique for correcting valgus deformity.

A retrospective review of 54 patients between Jan.2018 and Apr.2023 who underwent primary TKA with valgus deformity using the technique of lateral contractures structure release called "inverted cruciform release" was performed. Clinical measurements including Visual Analogue Scale (VAS), range of motion (ROM) of knee, Hospital for Special Surgery Score (HSS), hip-knee-ankle angle (HKAA), complications and survivorship.

Mean age of patients was 70.67 ± 6.22 years and mean body mass index was 25.36 ± 3.74 kg/m². Follow-up duration was a mean of 44.61 ± 16.50 months (range 25 to 85 months). VAS, ROM of knee, HSS were significantly improved post-operation respectively (P < 0.001). HKAA was corrected from 10.95 ± 5.75° (range, 2.0°-29.7°) to 0.77 ± 2.54° (range, -8.2°-4.7°). Standard PS (83.33%) and mid-level constraint (14.8%) inserts were used except one patient used the constrained condylar knee (CCK) due to extremely severe valgus deformity combined with insufficiency of medial collateral ligament (MCL). No common peroneal nerve (CPN) palsy or injury was found in all patients. And during the follow-up period, there was no infection, instability, recurrent valgus deformity or other reasons that would require revision.

Technique of "inverted cruciform release" with no constrained arthroplasty showed satisfied clinical outcomes for the restoration of soft tissue balance and neutral alignment to correct valgus deformity in TKA.