Total knee arthroplasty in severe genu valgus. Five to 14 years followup.

Introduction: valgus malalignment is a complex, multiplanar deformity characterized by bone alterations and soft-tissue abnormalities. Several surgical techniques have been described for valgus knee, and the sequence of tight lateral structures release and necessity of constrained prosthesis were addressed. Total Knee Arthroplasty (TKA) in valgus deformity remains a surgical challenge for orthopaedic surgeons. The objectives of the study were to evaluate our mid and long-term results in the surgical treatment of severe valgus disease, and describe the applied surgical technique. Materials and Methods: a clinic-radiographic classification was developed, and patients treated for severe genu valgus were discriminated. We retrospectively evaluated 42 TKA in 39 patients, with an average follow-up of 9,2 years. Knee Society Score (KSS) was used for clinical evolution, and the last control best quality radiography was considered for radiographic evaluation. Survivorship analysis contemplated need for revision for any reason and for mechanical failure. Results: postoperative average KSS was 83,3, with marked improvement in parameters pain and range of movement. Constrained implants were utilized in 16,7% of cases. Postoperative alignment was on average 5,9°. Two patients underwent revision surgery, having achieved a prosthetic survivorship for mechanical failure of 97,6%. We did not have any revision because of infection. Conclusion: a meticulous physical examination and proper preoperative radiographs are mandatory. The decision of using a constrained device is done intraoperative. Appropriate soft-tissue release is extremely significant. Despite the surgical technique, a constrained prosthesis utilization is limited. We recommend our technique as a low-demanding procedure, with encouraging mid and long-term results. Key words: valgus, deformity, severe, TKA, release, surgical technique