Correction of severe valgus deformity of knee osteoarthritis with non-constrained total knee arthroplasty implant: A case report

INTRODUCTION: Knee osteoarthritis with valgus deformity presents a surgical challenge that must be solved during total knee arthroplasty (TKA). In some case whereby ligament imbalance is found, constrained implant should be used. Unfortunately, the implant is not always readily accessible in some developing countries. The objective of this paper is to provide alternative solution to such case. PRESENTATION OF CASE: We reported a 71-year-old female patient with a painful and fixed valgus deformity of her right knee. Preoperatively, the patient's right knee range of motion (ROM) was 10-145 of flexion with a 32 fixed valgus deformity. A constrained implant was not accessible. To balance the ligament, Medial Collateral Ligament (MCL) origin was shifted to superior and anterior. A non-constrained implant was used. The valgus deformity was corrected intraoperatively and ROM achieved 0-140 of flexion. DISCUSSION: It is crucial that attention is given not only to the restoration of proper bony alignment but even more importantly to soft tissue balancing. By using the non-constrained implant, the cost can also be reduced and suitable for developing countries with limited coverage of state insurance. CONCLUSION: Three months after the surgery, the patient achieved stable and painless knee with 10-90 of flexion and complete correction of her valgus deformity. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of US Publishing Group Ltd.