Total knee replacement in severe genu varum deformity

In patients with osteoarthritis (OA) and severe osseous deformity of the knee, total knee replacement (TKR) is a major challenge. If the preoperative deformity exceeds 15°, restoration of the correct mechanical alignment will be difficult to achieve. In the management of medial compartment OA associated with a deformity of more than 15°, there is no agreement on the policy to adopt. The first step to be taken is a detailed analysis of the deformity, to determine where it is articular (wear, laxity) or extra-articular (constitutional or acquired bony deformity). The options open to the surgeon are: isolated valgus osteotomy (with TKR at a later stage), TKR or one-stage opening-wedge tibial valgus osteotomy and TKR. This chapter examines the different options and describes the authors' preferred strategy