A 65-year-old man with severe bilateral knee osteoarthritis and a valgus deformity of 18° undergoes total knee replacement. Intraoperatively, the lateral structures are found to be tight even after soft tissue release. The most appropriate technique to balance the knee and correct the residual valgus is:
- A Medial release of the deep MCL to allow further valgus correction
- B Lateral femoral epicondylar osteotomy (epicondylar slide) to lengthen the lateral structures ✓
- C Use of a constrained prosthesis without soft tissue release
- D Downsizing the femoral component to reduce the lateral gap
Explanation
In fixed valgus deformity, sequential lateral release is performed: first the iliotibial band, then popliteus, then lateral collateral ligament. If adequate balance cannot be achieved with soft tissue release alone, lateral epicondylar osteotomy (epicondylar slide) slides the origin of the LCL-popliteus complex distally, effectively lengthening these structures without completely releasing them. This preserves ligamentous continuity while correcting the deformity. Indiscriminate over-release risks lateral instability. Constrained prostheses (C) are a fallback but increase stress at the bone-implant interface and shorten implant longevity.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.