Total Knee Replacement in Valgus Knee


  • Mohammad Triadi Wijaya Department of Orthopaedic & Traumatology Universitas Indonesia, DR. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Ismail Hadisoebroto Dilogo Department of Orthopaedic & Traumatology Universitas Indonesia, DR. Cipto Mangunkusumo Hospital, Jakarta, Indonesia



Total Knee Replacement, Genu Valgum, Arthroplasties, Total Knee Arthroplasty


Total knee replacement (TKR) in valgus knee patients presents unique challenges and requires careful consideration of various factors to ensure optimal outcomes. Valgus knee deformity can be associated with various underlying conditions,
including autoimmune diseases like rheumatoid arthritis. Nearly 10% of patients undergoing total knee replacement have valgus knee deformity, which is associated with poorer functional outcomes than varus knees. When planning TKR
procedures for patients with valgus knee deformity, it is crucial to identify the underlying reason, as the surgical strategy and implant selection may vary according to the individual etiology and patient factor. Proper alignment and stability of the knee joint need precise bone cuts, soft tissue balance, and implant design. Soft tissue balance ensures optimal joint function and range of motion. A comprehensive pre-operative planning process that takes into account these factors
is essential for achieving the best possible outcomes and patient satisfaction in TKR for valgus knee patients. Different surgical approaches, such as the medial parapatellar and lateral parapatellar approaches, offer distinct advantages and
disadvantages in treating valgus knee patients, and the choice of approach should be based on the surgeon's expertise and the patient's specific anatomy and deformity. For a successful output, the coronal, sagittal, and rotational alignment
must be in proper proportion. Therefore, before performing a total knee replacement on a valgus knee, it is necessary to have a thorough understanding of the problem and the treatment options available.


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Alesi D, Meena A, Fratini S, Rinaldi VG, Cammisa E, Lullini G, et al. Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg. 2022;106(1):1–8.

Paley D. Principles of Deformity Correction. Springer Berlin / Heidelberg; 2002.

Shen Z, Wang H, Duan Y, Wang J, Wang F. Application of 3D printed osteotomy guide plate-assisted total knee arthroplasty in treatment of valgus knee deformity. J Orthop Surg Res. 2019 Oct;14(1):327.

J. George M. Valgus Deformity Correction in Total Knee Replacement: An Overview. Knee Surg - Reconstr Replace. 2020;1–13.

Lange J, Haas SB. Correcting severe valgus deformity. Bone Joint J. 2017 Jan;99-B(1):60–4.

Scott RD. Total Knee Arthroplasty. Second. Philadelphia: Elsevier; 2015.

Nikolopoulos D, Michos I, Safos G, Safos P. Current surgical strategies for total arthroplasty in valgus knee. World J Orthop. 2015 Jul;6(6):469–82.

Mullaji AB, Shetty GM. Deformity Correction in Total Knee Arthroplasty. Springer Science and Business Media; 2014. 59–71 p.

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 Sep;87(Pt 2):271–84.

Rossi R, Rosso F, Cottino U, Dettoni F, Bonasia DE, Bruzzone M. Total knee arthroplasty in the valgus knee. Int Orthop. 2014 Feb;38(2):273–83.

Gurel R, Morgan S, Elbaz E, Snir N, Gold A, Warschawski Y. Good clinical and radiological outcomes of the varus-valgus constrained mobile-bearing implant in revision total knee arthroplasty. Int Orthop. 2021 May;45(5):1199–204.

Song SJ, Lee HW, Kim YK, Park CH. Fixed distal femoral resection with a valgus cutting angle of 3° is more appropriate in intra-articular valgus deformity than juxta-articular valgus deformity in total knee arthroplasty: a retrospective single center study. Ann Jt. 2022;7(March):1–11.

Lee SM, Kim HS, Jang JH, Ahn TY, Suh JT, Rhee SJ. Coronal plane femoral bowing in Far East Asians: implications for the strategy of distal femoral resection in total knee arthroplasty. J Orthop Surg Res. 2022 Nov;17(1):488.

ALShammari SA, Choi KY, Koh IJ, Kim MS, In Y. Total knee arthroplasty in femoral bowing: does patient specific instrumentation have something to add? A randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):321.

Raut V, Matar HE, Singh A. Satisfactory medium-term outcomes with lateral condylar sliver osteotomy to correct valgus deformity in total knee replacements. Knee Surg Sports Traumatol Arthrosc. 2020 May;28(5):1394–9.

Aurich M, Lenz M, Best N. A Modified Lateral Approach for Total Knee Replacement in Type 2 Valgus Deformity. Orthopedics. 2017 Sep;40(5):313–6.

Cheng W, Li Z, Zhang J, Cao Q, Yu H, Qi L, et al. A lateral parapatellar approach with iliotibial band dissection from the Gerdy tubercle for total knee arthroplasty of the valgus knee. Exp Ther Med. 2021 Jan;21(1):38.

Li H, Ponzio DY, Ong A, Wei W, Wang B, Li Z, et al. Erratum: Total Knee Arthroplasty for Fixed Valgus Deformity Correction Using a Modified Lateral Parapatellar Approach. J Knee Surg. 2020 Apr;33(4):e2.

Dudek P, Marczak D, Okoń T, Grzelecki D, Szneider J, Kowalczewski J. Lateral or Medial Parapatellar Surgical Approach to the Valgus Osteoarthritic Knee? A Retrospective Single-Center Study. J Clin Med. 2022 Oct;11(19).

Schnurr C, Csécsei G, Nessler J, Eysel P, König DP. How much tibial resection is required in total knee arthroplasty? Int Orthop. 2011;35(7):989–94.

Lee SS, Lee YI, Kim DU, Lee DH, Moon YW. Factors affecting femoral rotational angle based on the posterior condylar axis in gap-based navigation-assisted total knee arthroplasty for valgus knee. PLoS One. 2018;13(5):1–11.

Arima J, Whiteside LA, McCarthy DS, White SE. Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Joint Surg Am. 1995 Sep;77(9):1331–4.

Plaskos C, Wakelin EA, Shalhoub S, Lawrence JM, Keggi JM, Koenig JA, et al. Frequency of soft-tissue releases and their effect on patient reported outcomes in robotic-assisted TKA. In: EPiC Series in Health Sciences. 2020.

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

Karachalios T, Sarangi PP, Newman JH. Severe varus and valgus deformities treated by total knee arthroplasty. J Bone Joint Surg Br. 1994 Nov;76(6):938–42.

Li H, Ponzio DY, Ong A, Wei W, Wang B, Li Z, et al. Total Knee Arthroplasty for Fixed Valgus Deformity Correction Using a Modified Lateral Parapatellar Approach. J Knee Surg. 2020 Apr;33(4):372–7.

Lü H, Guan Z, Zhou D, Yuan Y. Total knee replacement in valgus knee. Chinese J Surg. 2005 Oct;43(20):1305–8.

Boyer B, Pailhé R, Ramdane N, Eichler D, Remy F, Ehlinger M, et al. Under-corrected knees do not fail more than aligned knees at 8 years in fixed severe valgus total knee replacement. Knee Surg Sports Traumatol Arthrosc. 2018 Nov;26(11):3386–94.

Lombardi AVJ, Dodds KL, Berend KR, Mallory TH, Adams JB. An algorithmic approach to total knee arthroplasty in the valgus knee. J Bone Joint Surg Am. 2004;86:62–71.

Rajgopal A, Dahiya V, Vasdev A, Kochhar H, Tyagi V. Long-term results of total knee arthroplasty for valgus knees: soft-tissue release technique and implant selection. J Orthop Surg. 2011 Apr;19(1):60–3.

McAuley JP, Collier MB, Hamilton WG, Tabaraee E, Engh GA. Posterior cruciate-retaining total knee arthroplasty for valgus osteoarthritis. Clin Orthop Relat Res. 2008 Nov;466(11):2644–9.

Politi J, Scott R. Balancing severe valgus deformity in total knee arthroplasty using a lateral cruciform retinacular release. J Arthroplasty. 2004 Aug;19(5):553–7.

Sabatini L, Risitano S, Rissolio L, Bonani A, Atzori F, Massè A. Condylar constrained system in primary total knee replacement: our experience and literature review. Ann Transl Med. 2017 Mar;5(6):135.

Ren J, Zhang X, Wulamu W, Yushan N, Aaimaiti A, Cao L. Total knee arthroplasty with the least-constrained implant possible for type II valgus knee > 20°: a 3-14 years’ follow-up. Arthroplasty. 2020 Jun;2(1):17.

Mancino F, De Martino I, Burrofato A, De Ieso C, Saccomanno MF, Maccauro G, et al. Satisfactory mid-term outcomes of condylar-constrained knee implants in primary total knee arthroplasty: clinical and radiological follow-up. J Orthop Traumatol Off J Ital Soc Orthop Traumatol. 2020 Dec;21(1):22.

Mullaji AB, Shetty GM. Lateral Epicondylar Osteotomy Using Computer Navigation in Total Knee Arthroplasty for Rigid Valgus Deformities. J Arthroplasty [Internet]. 2010;25(1):166–9. Available from:

Mou P, Zeng Y, Yang J, Zhong H, Yin SJ, Li RB. The Effectiveness of Medial Femoral Epicondyle Up-Sliding Osteotomy to Correct Severe Valgus Deformity in Primary Total Knee Arthroplasty. J Arthroplasty [Internet]. 2018;33(9):2868–74. Available from:

Triangga AFR, Magetsari RMSN, Purnomo G, Rahmansyah N, Riyadli M, Sibarani T. A case series of total knee arthroplasty with a non-constrained implant in 2nd and 3rd degree valgus deformity in knee osteoarthritis and medial collateral ligament insufficiency. Int J Surg Case Rep [Internet]. 2023;106(December 2022):108162. Available from:

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