Total knee arthroplasty in patients with extra-articular deformity: which strategy to choose?(Case report and literature review)

Background Extraarticular deformity of the femur or tibia may be critical for the success of primary total knee arthroplasty (TKA). Recognizing an extraarticular deformity preoperatively allows a surgeon to choose between various management strategies. The surgical treatment options for correction of an extraarticular deformity include (1) primary TKA, (2) simultaneous corrective osteotomy and TKA and (3) staged corrective osteotomy and delayed TKA. Objective To substantiate differentiated approach to treatment strategies for osteoarthritic knee with extraarticular deformity based on international and our own experience. Material and methods Comparative analysis of current literature on surgical treatment of extraarticular deformities in arthritic knees was produced. The differentiated approach was illustrated by a clinical instance of a 35-year-old patient with bilateral end-stage gonarthrosis associated with extraarticular deformity of both lower limbs. Staged treatment was considered for the congenital multiplanar multilevel deformity in the shaft of the left femur with 26º valgus alignment, procurvatum, external rotation to be corrected with bifocal osteotomy addressing all components of the deformity and stabilized with interlocking intramedullary nail...