J Knee Surg 2012; 25(05): 355-360
DOI: 10.1055/s-0031-1299668
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Posterolateral Capsular Release for Correction of Valgus Deformity

Ofir Chechik
1   Department of Orthopedics, Sourasky Medical Center, Tel Aviv, Israel
,
Chen Mayer
2   Medical School, Tel Aviv University, Tel Aviv, Israel
,
Michael Drexler
1   Department of Orthopedics, Sourasky Medical Center, Tel Aviv, Israel
,
Amir Sternheim
1   Department of Orthopedics, Sourasky Medical Center, Tel Aviv, Israel
,
Nimrod Snir
1   Department of Orthopedics, Sourasky Medical Center, Tel Aviv, Israel
,
Shmuel Dekel
1   Department of Orthopedics, Sourasky Medical Center, Tel Aviv, Israel
› Author Affiliations
Further Information

Publication History

27 July 2011

21 August 2011

Publication Date:
03 May 2012 (online)

Abstract

Achieving coronal balance during arthroplasty of a valgus knee presents a challenge for the surgeon. Various techniques for lateral release had been described with no consensus among surgeons. We retrospectively reviewed 42 consecutive patients (38 women, mean age 72.7 years, follow-up 42 ± 23 months) with a valgus deformity who were operated while using a posterolateral capsular release as the sole method of lateral release. All knees were successfully balanced, without the need for further release of other structures. Valgus angles improved from 17.5 ± 4.6 degrees (range 11 to 31) to 6.3 ± 2.2 degrees (range 2 to 11) (p < 0.0001), and the knee and functional scores improved from 5.4 ± 17.7 and 24.8 ± 24.7 to 88.2 ± 15.8 and 70 ±  30, respectively (p < 0.0001) at last follow-up. One patient developed transient peroneal palsy after correction of severe deformity. The posterolateral capsule release, which is similar to that of the “inside-out” technique, provides a simple and safe solution for balancing a valgus knee.

 
  • References

  • 1 Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am 2005; 87 (Pt 2, Suppl 1) 271-284
  • 2 Lombardi Jr AV, Dodds KL, Berend KR, Mallory TH, Adams JB. An algorithmic approach to total knee arthroplasty in the valgus knee. J Bone Joint Surg Am 2004; 86-A (Suppl. 02) 62-71
  • 3 Boyer P, Boublil D, Magrino B, Massin P, Huten D. Guepar Group. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop 2009; 33 (6) 1577-1583
  • 4 Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg Am 2004; 86-A ((12)) 2671-2676
  • 5 Insall J, Scott WN, Ranawat CS. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 1979; 61 (2) 173-180
  • 6 Clarke HD, Fuchs R, Scuderi GR, Scott WN, Insall JN. Clinical results in valgus total knee arthroplasty with the “pie crust” technique of lateral soft tissue releases. J Arthroplasty 2005; 20 (8) 1010-1014
  • 7 Clarke HD, Scuderi GR. Correction of valgus deformity in total knee arthroplasty with the pie-crust technique of lateral soft-tissue releases. J Knee Surg 2004; 17 (3) 157-161
  • 8 Engh GA. The difficult knee: severe varus and valgus. Clin Orthop Relat Res 2003; (416) 58-63
  • 9 Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; (248) 9-12
  • 10 Mihalko WM, Whiteside LA, Krackow KA. Comparison of ligament-balancing techniques during total knee arthroplasty. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 132-135
  • 11 Kanamiya T, Whiteside LA, Nakamura T, Mihalko WM, Steiger J, Naito M. Ranawat Award paper. Effect of selective lateral ligament release on stability in knee arthroplasty. Clin Orthop Relat Res 2002; (404) 24-31
  • 12 Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year followup of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 1997; (345) 29-37
  • 13 Liu J, Sun Z, Zhang Y , et al. [Treatment of valgus deformity by total knee arthroplasty with modified Ranawat soft tissue balance technique]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009; 23 (9) 1034-1037
  • 14 Bruzzone M, Ranawat A, Castoldi F, Dettoni F, Rossi P, Rossi R. The risk of direct peroneal nerve injury using the Ranawat “inside-out” lateral release technique in valgus total knee arthroplasty. J Arthroplasty 2010; 25 (1) 161-165
  • 15 Aglietti P, Lup D, Cuomo P, Baldini A, De Luca L. Total knee arthroplasty using a pie-crusting technique for valgus deformity. Clin Orthop Relat Res 2007; 464: 73-77
  • 16 McAuley JP, Collier MB, Hamilton WG, Tabaraee E, Engh GA. Posterior cruciate-retaining total knee arthroplasty for valgus osteoarthritis. Clin Orthop Relat Res 2008; 466 (11) 2644-2649
  • 17 Beverland D. Management of the severe varus and valgus knee using the low contact stress rotating platform. Orthopedics 2006; 29 (9, Suppl) S60-S63
  • 18 Politi J, Scott R. Balancing severe valgus deformity in total knee arthroplasty using a lateral cruciform retinacular release. J Arthroplasty 2004; 19 (5) 553-557