Total knee replacement in severe deformities

ABSTRACT

Total knee replacement in severe deformities is a challenging procedure. Varus and flexion are the commonest deformities seen. Thorough soft tissue release and balancing is the key to a successful outcome. We tried to correct these cases without the need for expensive augments and specialized prosthesis. Our study included 30 knees in 23 patients with severe flexion and varus deformities. The average preoperative varus deformity was 20° [range, 14-38°] and the average flexion deformity was 15.6° [range, 5-30°]. Bone graft was used in 8 cases [26%] and tibial stems in 2 cases [6%]. No constrained prosthesis was used. The average follow up was 31 months [range, 8-65 months]. The average postoperative range of flexion was 115° [range, 90-147°], range of extansion between 0-6° and the average varus correction was 26° [range, 12-42°]. At the final follow up, we had 15 excellent, 12 good, 2 fair and 1 poor functional result, giving a 90% success rate. Our techniques resulted in restoration of alignment and stability without the need for wedges or constrained prosthesis with encouraging early and mid-term results: