Valgus Knee TKR Surgery: Key Technical Considerations

Preoperative Assessment and Planning

Full-length hip-to-ankle weight-bearing radiographs are required for precise alignment assessment, according to the American Academy of Orthopaedic Surgeons 1
Standard anteroposterior, lateral, and axial views are necessary for a comprehensive evaluation, as recommended by the American Academy of Orthopaedic Surgeons 1

The American Academy of Orthopaedic Surgeons recommends using cruciate-retaining implants in 92% of valgus knees when adequate medial collateral ligament function is preserved after lateral release, with strong evidence showing no difference between posterior-stabilized and posterior cruciate-retaining designs 2
Constrained implants should be reserved for severe deformities with medial collateral ligament insufficiency after soft tissue balancing, as suggested by the American Academy of Orthopaedic Surgeons 2
Strong evidence supports using either cemented or noncemented tibial component fixation with similar outcomes, according to the American Academy of Orthopaedic Surgeons 2
The American Academy of Orthopaedic Surgeons also recommends using either all-polyethylene or modular tibial components, with strong evidence supporting similar outcomes 2

The American Academy of Orthopaedic Surgeons found strong evidence showing no difference in pain or function with or without patellar resurfacing, but moderate evidence supports patellar resurfacing may decrease cumulative revision surgeries after 5 years 1, 2
Strong evidence shows no difference in outcomes or complications with the use of intraoperative navigation or robotic systems, according to the American Academy of Orthopaedic Surgeons 2, 3
The American Academy of Orthopaedic Surgeons recommends against using patient-specific instrumentation, as it provides no benefit over conventional instrumentation 3

The American Academy of Orthopaedic Surgeons recommends starting rehabilitation on the day of TKA to reduce hospital length of stay, with strong evidence supporting supervised exercise program during first 2 months improves physical function 1
Strong evidence shows no improvement in outcomes with the use of continuous passive motion, according to the American Academy of Orthopaedic Surgeons 1
Pharmacologic prophylaxis should be started at least 12 hours after surgery completion and continued for a minimum of 10-14 days, with extended prophylaxis up to 35 days for high-risk patients, as recommended by the American Society of Regional Anesthesia and Pain Medicine 4, 5