Document Detail

Surgical technique: Computer-assisted sliding medial condylar osteotomy to achieve gap balance in varus knees during TKA.
MedLine Citation:
PMID:  23283680     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Extensive posteromedial release to correct severe varus deformity during TKA may result in mediolateral or flexion instability and may require a constrained implant. We describe a technique combining computer navigation and medial condylar osteotomy in severe varus deformity to achieve a primary goal of ligament balance during TKA.
DESCRIPTION OF TECHNIQUE: The goal of this procedure was to achieve mediolateral gap balance in varus knees with rigid, recalcitrant medial contracture, with or without excessive lateral laxity, not amenable to extensive medial soft tissue releases. A sliding medial condylar osteotomy (SMCO) was performed under navigation guidance and the condylar block internally fixed using cancellous screws.
METHODS: We prospectively evaluated mediolateral laxity, Knee Society scores, and knee ROM after SMCO in 12 varus arthritic knees in 11 patients (five men, six women) undergoing TKA with a minimum followup of 2 years (mean, 2 years; range, 2-2.5 years).
RESULTS: The degree of mediolateral knee laxity improved from Grade 2 (in four knees) and Grade 3 (in eight knees) preoperatively to Grade 1 (< 5 mm) in all knees at last followup. Mean Knee Society score improved from 30 (range, 10-54) to 92 (range, 86-100). Mean knee flexion improved from 106° (range, 90°-120°) to 112° (range, 100°-124°), and no knee had any extensor lag or residual flexion deformity (> 5°). Three knees had asymptomatic fibrous union at the osteotomy site.
CONCLUSIONS: Computer-assisted SMCO in varus knees with recalcitrant medial contracture achieves improved mediolateral stability and knee function after TKA. Our technique uses navigation to accurately reposition the medial condylar block to equalize medial and lateral gaps, thereby ensuring a stable well-aligned knee without deploying constrained implants.
Arun B Mullaji; Gautam M Shetty
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-02     Completed Date:  2013-05-22     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1484-91     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Arthritis / diagnosis,  physiopathology,  surgery*
Arthroplasty, Replacement, Knee / adverse effects,  methods*
Biomechanical Phenomena
Joint Instability / diagnosis,  physiopathology,  surgery*
Knee Joint / physiopathology,  radiography,  surgery*
Middle Aged
Osteotomy / adverse effects,  methods*
Range of Motion, Articular
Recovery of Function
Retrospective Studies
Surgery, Computer-Assisted* / adverse effects
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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