To study surgical outcome of various surgical procedures of lateral release in valgus knee in total knee arthroplasty


  • Ankit Patel Department of Orthopaedics, GCS medical college and Hospital, Ahmedabad
  • Hiren Shah Department of Orthopaedics, GCS medical college and Hospital, Ahmedabad
  • Aalok Shah Department of Orthopaedics, GCS medical college and Hospital, Ahmedabad
  • Sharvil Hetavbhai Gajjar Department of Orthopaedics, GCS medical college and Hospital, Ahmedabad
  • Ripple Shah Department of Orthopaedics, GCS medical college and Hospital, Ahmedabad
  • Suril Shah Department of Orthopaedics, GCS medical college and Hospital, Ahmedabad



Total knee arthroplasty, Knee society score, Krakow classification


Background: Fixed valgus deformity presents a major challenge in total knee arthroplasty (TKA), especially in moderate or severe cases. In knee arthritis, fixed-varus deformity (50 to 55%) is three times more frequent than fixed-valgus deformity (10 to 15%). Valgus deformity occurs more commonly in rheumatoid arthritis and also in osteoarthritis with hypoplasia of the lateral femoral condyle. Valgus deformity is often associated with flexion or external rotation contracture of the knee. In this study we aim to study the surgical outcome of total knee replacement in valgus deformity via standard medial parapatellar approach using various techniques like Pie –Crusting release of lateral structures or combined technique of pie crusting and standard release of lateral structures. Aim: To evaluate surgical outcome of various surgical techniques via standard medial parapatellar approach in fixed valgus deformity in Total Knee Arthroplasty.

Methods: The present study involved both male and female patients with osteoarthritis of knee with valgus deformity. In present series, 26 consecutive patients of osteoarthritis with valgus deformity operated with total knee replacement were included. Previously operated cases of high tibial osteotomy and patients having contraindication for TKA were excluded from the study.

Results: Valgus angle in this study was between 13 to 27 degree with average 17.84 degree. These results were comparable to many such similar studies. In our study, post operatively, knee society score was average 87.69 and function knee score was 82.5. Mean range of motion was 105 degree. In our study, mean tibiofemoral alignment improved from 17.84 valgus to 4.7 valgus.

Conclusions: Knee society score is excellent with both techniques and there is no difference in both techniques Iliotibial band and posterolateral capsule are most common structures that require release. Initial ligament balancing should be done with pie crusting and then sequential lateral release if require. 


Krackow KA, Jones MM, Teeny SM. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop. 1991;(273):9-18.

Kunz M. A Non-CT Based Total Knee Arthroplasty System Featuring Complete Soft-Tissue Balancing. Medical Image Computing and Computer-Assisted Intervention. 2001;2208:409-15.

D’Lima DJ, Patil S, Steklov N, Colwell Jr CW. An ABJS BestPaper: Dynamic intraoperative ligament balancing for totalknee arthroplasty. Clin Orthop. 2007;463:208-12.

Unitt L, Sambatakakis A, Johnstone D, Briggs TW, Balancer Study Group. Short-term outcome in total knee replacement after soft-tissue release and balancing. J Bone Joint Surg (Br). 2008;90:159-65.

Parratte S, Pagnano MW. Instability after total knee arthroplasty.J Bone Joint Surg (Am). 2008;90:184-94.

Hood RW, Vanni M, Insall JN. The correction of knee alignment in 225 consecutive total condylar knee replacements. Clin Orthop. 1981;160:94-105.

Lu HS, Guan ZP. Total knee replacement in valgus knee. Zhonghuan wai. 2005;43(20):1305-8.

Rajgopal A, Dahiya V, Vasdev. Long term result of total knee arthroplasty in valgus knee; soft tissue release and selection of implant. J Orthop Surg. 2011;19(1):60-3.

Stehlík J, Musil D, Held M, Stárek M. Z plasty for valgus deformity in total knee arthroplasty. Acta Chir Orthop Traumatol Cech. 2006;73(3):169-75.

Aglietti P, Lup D, Cuomo P, Baldini A, De Luca L. Total knee replacement using pie crusting technique for valgus deformity. Clin Orthop Relat Res. 2007;464:73-7.

Larke HD, Fusch R. Clinical Results in Valgus Total Knee Arthroplasty With the “Pie Crust” Technique of Lateral Soft Tissue Releases. J Arthroplasty. 2005;20(8):1010-4.

Chechik O, Mayer C, Drexler M, Sternheim A, Snir N, Dekel S. Posterolateral capsule release for correction of valgus deformity. J Knee Surg. 2012;25(5):355-60.

Boyer P, Boubil D, Magrino B. Total knee replacement in fixed valgus deformity using a lateral approach: a role of automatic ITB release for successful balancing. Int Orthop. 2009;33(6):1577-83.

Whiteside LA. Selective ligament release in total knee arthroplasty in valgus deformity. Clin Orthop Relat Res. 1999;367:130-40.

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(1 suppl 2):271-84.






Original Research Articles