Results of total knee arthroplasty with medial epicondylar osteotomy to correct varus deformity.

The clinical results of using medial epicondylar osteotomies to correct varus deformities in total knee arthroplasties were investigated. Unlike the traditional method of subperiosteal stripping of tibial ligaments, this alternative does not damage ligaments. Between 1991 and 1996, the senior author performed medial epicondylar osteotomies in 80 patients (93 knees) with primary total knee arthroplasty; of these, 60 patients (70 knees) were available for 2- to 4-year followup. At followup, no patients reported knee instability. Mean varus and valgus stability measured 14.2 points (Knee Society scale, 0-15 points). The Knee Society clinical score was 93 points, compared with a preoperative score of 42 points. The mean range of motion at followup was 111 degrees, compared with a preoperative mean of 101 degrees. The postoperative tibiofemoral angle on full limb radiographs taken with the patient weightbearing averaged 7 degrees valgus, compared with an average 6 degrees varus preoperative angle. Ninety-five percent of the patients were satisfied and reported less pain and improved knee function. Bone union occurred in 54% of the knees and fibrous union occurred in 46%. Focal tenderness, restricted motion, or other symptoms were not associated with fibrous union. The results show that epicondylar osteotomy for varus knee deformity provides excellent patient satisfaction, knee stability, motion, and deformity correction.