LIGAMENT RELEASE AND BONE-GRAFTING IN TOTAL ARTHROPLASTY OF THE VARUSKNEE

A simplified technique is described for restoring joint line position, correcting bony defects, and achieving ligament balance in the varus knee. The thickness of the implant is resected based on the intact sur face at a predetermined 5-degrees or 7-degrees valgus angle. Resulting medial femoral and tibial defects are grafted with morselized cancell ous autograft, and the medial ligaments are released from the tibial s urface to achieve appropriate matching of varus/valgus stability. Four hundred twenty-three knees with varus deformity of 5-degrees to 55-de grees were followed for 2 to 7 years after surgery. Of the 98 knees wi th moderate varus deformity, two had grafting of minor tibial defects and none had femoral grafting. Of the 36 with severe varus deformity, three had grafting of the femoral condyle distal surface and 26 had me dial tibial plateau grafting. Mean valgus angle 1 year after surgery w as 5.3-degrees, and yearly follow up revealed no tendency for deterior ation of alignment. Bone graft collapse was not found in any knee. Rad iographic analysis of the tibial grafts routinely demonstrated trabecu lation of the graft 2 years postoperatively. Mean postoperative range of motion was 111-degrees 1 year after surgery and 115-degrees 2 years after surgery. No major complications were found as a result of eithe r bone grafting or ligament release. This simplified technique of rese ction of the bone surfaces to match the thickness of the implant is sa fe and effective in the severely deformed varus knee.