Extra-articular deformities in arthritic knees-a grueling challenge for arthroplasty surgeons: An evidence-based update

Vishesh Khanna, Senthil N. Sambandam, Munis Ashraf, Varatharaj Mounasamy

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Critical to the success of a total knee arthroplasty (TKA) is the anatomical alignment. This may appear as a challenge in an extra-articular deformity (EAD) that may be inherent in certain people or result from fracture malunion, congenital disorders, nutritional, metabolic and infective causes. This appraisal aimed at providing the reader with an up-todate overview of the research carried out on, and existent evidence of EAD correction while planning a TKA. We reviewed the current English literature on TKA in extra-articular knee deformities. Among the published data, a common initial approach of mandatory clinical and radiological assessment emerges as an obligatory step while handling cases with EAD. While several methods of managing the deformity and arthritis have been described, a broad division into intra-articular and extra-articular means can be deciphered. The relatively old-school, yet reliable thought process of extra-articular correction allows an all-inclusive restoration of alignment with the inherent complications related to the necessary osteotomy. A cohort of younger and more venturesome surgeons seem inclined towards performing navigated, intra-articular correction for mild to moderate and sometimes, severe deformities. The crux of the matter lies is obtaining a well-balanced knee without violating the all-important cruciates. Restoring the patient’s ambulatory status seems sooner with the intra-articular methods which are also more precise in determining the axes and while removing minimum bone. Greatest satisfaction is accomplished in those with less grotesque, rotationallyaligned knees while meticulously balancing soft-tissues and encouraging earlier weight-bearing.

Original languageEnglish (US)
Article number7374
Pages (from-to)124-135
Number of pages12
JournalOrthopedic Reviews
Issue number4
StatePublished - 2017
Externally publishedYes


  • Complex total knee replacement
  • Extra-articular deformities
  • Intra-articular versus extra-articular correction
  • Navigated total knee arthroplast

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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