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Extra-articular tibial deformity management in total knee replacement.

Background
Presence of an extra-articular deformity in the femur or tibia poses a challenge to the surgeon undertaking knee replacement procedure. The conundrum is whether to correct the deformity beforehand, or accept the deformity and compensate for this through placement of the implant.


Material and Methods
This is a retro-spective study comprising six patients who had a knee replacement in the presence of an extra-articular deformity of the tibia treated at our centre. All six had the knee replacement without correction of deformity. The data evaluated included clinical outcome, mechanical axis correction, type of implant, and the use of any software / computer guidance.
The deformity was managed through planning of tibial resection without the need for pre-operative deformity correction.


Results
Mean age was 66.5 years. Mean coronal plane deformity in the tibia was 8.6 degrees. The hip- knee-ankle improved from a mean 12.6 degrees to 4 degrees. Mean Oxford knee score improved from a mean of 19 to 33.6.


Conclusion
Planning the tibial resection on the basis of mechanical axis of tibia allows correction of alignment without the need for preoperative correction.
Correction of the deformity may not be needed if the maximum tibial resection is less than 15 mm.