Varus Knee Deformity

Varus Knee Deformity

Kapil Mehrotra

Daniel J. Berry

Key Concepts

  • Balancing the varus knee begins with making bone cuts that restore neutral (or near-neutral) mechanical alignment to the knee, followed by soft tissue management to obtain even (or near-even) soft tissue tension on the medial and lateral sides of the knee.

  • In the great majority of cases, soft tissue management consists of sequential releases of tight soft tissue structures on the medial side of the knee in an iterative manner.

  • Overrelease of medial soft tissues is a constant concern and should be avoided to minimize risk of instability.

  • Constrained implants providing extra varus/valgus stability are reserved for severe cases.

Sterile Instruments and Implants

Sterile Instruments

  • Routine knee arthroplasty retractors

  • Periosteal elevator

  • 18-gauge needle

  • Electrocautery

  • Small oscillating saw


  • Routine knee arthroplasty instrumentation.

  • In cases with notable bone loss: metal augments to make up for bone deficiencies and implants to protect fixation.

  • In cases of severe deformity: constrained implants with stems to protect fixation.


  • Supine on operating table

  • Tourniquet on the thigh well above area of knee incision

Surgical Approaches

  • Use the surgeon’s routine preferred knee exposure in most cases: usually this will be medial parapatellar.

  • In more severe deformities, use medial parapatellar approach even if surgeon usually uses a different exposure for patients with minimal deformity.

Figure 53.1 ▪ A, Standing weight-bearing knee films. B, Longstanding hip to ankle radiograph to evaluate limb alignment and to use for preoperative planning.

Preoperative Planning

  • In addition to performing routine preoperative total knee arthroplasty (TKA) orthopedic and medical evaluation, carefully evaluate the degree to which the varus deformity is correctable with valgus stress and the degree to which lateral structures are stretched out with varus stress. This will provide an idea of the amount of soft tissue balancing that will be required.

  • Obtain long-standing hip to ankle radiographs to plan the bone cuts required to restore neutral or near-neutral mechanical limb alignment (Figure 53.1A and B).

  • Measure the tibiofemoral angle (angle created between the anatomic axis of the tibia and femur) to determine the severity of the varus deformity.

  • Evaluate for medial femoral condyle or medial tibial plateau bone deficiencies.

  • Identify posterior osteophytes on the lateral radiograph.

  • Template femoral and tibial component size.

  • Consider the need for augments, stems, or constrained implants.

Bone, Implant, and Soft Tissue Techniques

Bone Preparation

Dec 14, 2019 | Posted by in ORTHOPEDIC | Comments Off on Varus Knee Deformity

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