Knee arthroplasty and simultaneous high tibial osteotomy, for osteoarthritis and severe congenital tibia varum deformity

lntroduction Restoration of the normal mechanical axis of the knee and bala ncing of the surrounding soft tissues have been shown to have an important bearing on the final outcome of total knee arthroplasty. In knees with seve re congenital varum deformity these goals may be difficult to achieve. Material and methods In tour patients with osteoarthritis and severe congen ital knee varum deformity of more than 15 degrees, we performed a high tibi al valgus osteotomy with opening wedge, combined during the same procedure with total knee arthroplasty. Results As correction of the extra-articular deformity was obtained by the osteotomy, in none of the cases it was necessary to perform extensive soft tissue release or advancement to restore alignment. Postoperative X-rays de monstrated restoration of the normal mechanical axis in three cases, but in one case the angular correction of the osteotomy was insufficient and we o bserved a 9 degrees residual varus deformity. Discussion The osteoarthritic knee must be mechanically realigned for any t otal knee arthroplasty to be successful in the long term, Most commonly ang ular deformities are manifestations of the arthritic process, but sometimes , like in congenital varus deformity of the tibia, part of the deformation can be extra-articular in origin. In these cases, restoring alignment and s tability may be difficult to achieve. The association of high tibial valgus osteotomy with total knee arthroplasty permits the correction of the extra -articular deformity, by the osteotomy, without performing extensive soft t issue release, as would be needed in total knee arthroplasty alone. Conclusion Total knee arthroplasty associated with high tibial valgus osteo tomy seems to be a technically satisfying alternative in patients with oste oarthritis and severe congenital varus deformity of the tibia.