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World J Orthop. Jul 18, 2015; 6(6): 469-482
Published online Jul 18, 2015. doi: 10.5312/wjo.v6.i6.469
Current surgical strategies for total arthroplasty in valgus knee
Dimitrios Nikolopoulos, Ioannis Michos, George Safos, Petros Safos
Dimitrios Nikolopoulos, George Safos, Orthopaedic Department, Central Clinic of Athens, 10680 Athens, Greece
Ioannis Michos, D’ Orthopaedic Department, Asklepeion Voulas General Hospital, 16673 Voul, Greece
Petros Safos, Orthopaedic Department, Ikaria General Hospital, 83300 Ikaria, Greece
Author contributions: Nikolopoulos D and Michos I contributed equally to conception and design of the research; Nikolopoulos D, Safos G and Safos P designed the research on PubMed and analyzed the data; Nikolopoulos D and Michos I drafted the article and revised it critically; all authors approved the final version so as to be published.
Conflict-of-interest statement: We declare that there is no conflict of interest of any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dimitrios Nikolopoulos, PhD, Consultant, Orthopaedic Department, Central Clinic of Athens, Asklepiou 31 str., 10680 Athens, Greece. drdnikol@hotmail.com
Telephone: +30-210-3674064 Fax: + 30-210-3605110
Received: March 28, 2015
Peer-review started: March 28, 2015
First decision: April 10, 2015
Revised: April 23, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: July 18, 2015
Processing time: 108 Days and 11.3 Hours
Abstract

The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees.

Keywords: Valgus knee; Arthroplasty; Balancing soft tissue; Knee surgical approaches; Tibial tubercle osteotomy

Core tip: Knee arthroplasty in valgus deformity more than 10° is an orthopaedic challenge. During the operation, due to the deformities of the bone and soft tissue, there are many difficulties for the surgeon, such as the restoration of the mechanical axis, the orientation of the component and the stability of the knee joint. Our aim is to review the valgus knee anatomical variations, to assess the best approach and surgical technique for bone cuts and soft tissue management of valgus knees so as to succeed the best result.