Satisfactory medium-term outcomes with lateral condylar sliver osteotomy to correct valgus deformity in total knee replacements

Purpose

To describe a surgical technique in correcting valgus deformity during total knee replacement and evaluate medium-term clinical outcomes.

Methods

This was a retrospective consecutive series of total knee replacement for severe valgus deformity of patients who underwent a lateral ligament complex release with a sliver osteotomy of the lateral femoral condyle with a minimum 1-year follow-up and recording objective and patient-reported outcome measures.

Results

Twenty-three patients (25 knees) were included with median follow-up of 5 years (range 1–15 years) and average age 67.7 years (range 43–87). The primary diagnosis was osteoarthritis in 14 patients (61%) and inflammatory arthritis in 9 patients (39%). At final follow-up, the median mechanical tibiofemoral angle was restored to 4° (range 2–7) compared with a median valgus of 20° (range 13–30) preoperatively. This was statistically significant (P < 0.00001). Median Oxford Knee Score at final follow-up was 43 (range 36–48) indicating satisfactory outcomes. There were no revisions for any cause with a mean arc range of movement 110° (range 85–120).

Conclusion

This study shows that a technique utilising the familiar medial parapatellar approach, staged soft tissue releases, and a novel sliver lateral femoral condylar osteotomy with intact periosteum to release the lateral ligament complex leads to satisfactory medium-term outcomes, improved range of movement and patients’ reported outcome measures. Sliver osteotomy is a useful technique in correcting valgus deformity in total knee replacements at medium-term follow-up.

Level of evidence

IV.