Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement

Total knee arthroplasty is a challenging task in patients with severe varus
deformity. In most of these patients, an extensive medial release is needed thatmay lead to
instability. Medial epicondylar osteotomy may be a better substitute for complete medial
collateral release.
Materials and Methods Fourteen patients with bilateral knee osteoarthritis and severe
varus deformity were enrolled in this study. In one side, the patients underwent medial
epicondylar osteotomy for mediolateral imbalance if the only option was superficial medial
collateral ligament (MCL) release. In contralateral side, the extensive medial release was
performed and MCL was released either by pie-crusting technique or by subperiosteally
release. The results of the two sideswere compared. Patients were followed up for 12 months
after the operation. Physical examination, clinical questionnaires, and radiography findings
were recorded. Union of the osteotomies fragment and complications was evaluated.
Results The mean varus angle before surgery was 21.6� 4.7 degrees, which was
corrected to 8.6 � 2.9 degrees after operation with an extensive medial release. The
mean varus angle of contralateral side was 22.6� 1.7 degrees, which was corrected to
7.5� 2.3 degrees followingmedial femoral epicondyle osteotomy. Therewas no significant
difference in varus correction (p¼ 0.1). Medial joint line opening in valgus stress test was
2.7� 0.4mm in the osteotomized side and 3.5� 0.9mm in contralateral side. Mean range
of motion for the osteotomized side was 97.8� 4.3 degrees and 100.7� 2.7 degrees for
contralateral side (p¼ 0.6). Nonunion occurred in a case in the osteotomized side and no
medial instability was observed in medial release or osteotomies sides. No statistical
difference was recorded based on clinical questionnaires (Oxford and WOMAC [Western
Ontario and McMaster Universities Osteoarthritis Index] scores).
Conclusion Medial epicondylar osteotomy is a safe techniquewith thewell-controlled
medial extensive release in the patients with severe varus deformity during total knee
arthroplasty.