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The Journal of Bone and Joint Surgery (American). 2004;86:62-71
© 2004 The Journal of Bone and Joint Surgery, Inc.

An Algorithmic Approach to Total Knee Arthroplasty in the Valgus Knee

Adolph V. Lombardi, Jr., MD, Kathleen L. Dodds, BS, RN, Keith R. Berend, MD, Thomas H. Mallory, MD and Joanne B. Adams, BFA

Corresponding author: Adolph V. Lombardi Jr., MD
Joint Implant Surgeons, 720 East Broad Street, Columbus, OH 43215.
E-mail address: lombardiav@joint-surgeons.com

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   Introduction
 
The valgus arthritic knee presents as a complex deformity characterized by bone loss involving the lateral femoral condyle, contractures of the lateral soft-tissue structures, and concomitant instability. Patients with end-stage degenerative joint disease and valgus knee deformity have pain, limitation of activities of daily living, increasing angular deformity, and increasing instability. Total knee arthroplasty with valgus release is indicated when both mechanical and pharmacological nonoperative treatment modalities for end-stage degenerative joint disease have failed to relieve pain. The major contraindication to total knee arthroplasty is infection, and relative contraindications include young age, high activity level, and obesity.

The following steps should be followed as part of the standard physical examination for end-stage degenerative joint disease: (1) assess the patient's gait; (2) establish the presence of deformity (valgus-varus, flexion contracture, or extension contracture); (3) measure the range of motion; (4) evaluate the status of the extensor mechanism and the patellofemoral articulation; . . . [Full Text of this Article]


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