Simultaneous Femoral Osteotomy and Primary Total Knee Arthroplasty in Patient with Severe Extra-articular Deformity : A Case Report

Febrian Brahmana


Correction of an extra-articular deformity of the femur and tibia during total knee arthroplasty (TKA) in advanced knee osteoarthritis (OA) is a technically demanding procedure. The challenge is in the implications of the femoral and tibial realignment osteotomy in both coronal and sagittal planes either as step-by-step or simultaneous procedure. We herein describe an unusual case of knee OA characterized by fixed severe varus knee deformity, tibio-femoral bowing, and lower limb internal rotation. The patient underwent distal femoral osteotomy correction accompanied by TKA to restore mechanical and rotational alignment at the same time. A standard primary posterior stabilized (PS) implant was used. The procedure successfully provided stability, restored alignment and delivered good functional outcome. This case highlights the arthroplasty surgeon’s challenges, especially those who work in limited facilities.


Corrective Femoral Osteotomy, Knee Osteoarthritis, Total Knee Arthroplasty, Varus Knee Deformity,



Hafez AR, Mohammed A. Knee Osteoarthritis : A Review of Literature Physical Medicine and Rehabilitation. Phys Med Rehabil Int. 2014;1(5):8.

Sculco PK, Kahlenberg CA, Fragomen AT, Rozbruch SR. Management of Extra-articular Deformity in the Setting of Total Knee Arthroplasty. J Am Acad Orthop Surg. 2019;27(18):e819–30.

Vedoya S. Total Knee Arthroplasty Associate with Extra-Articular Deformity. MOJ Orthop Rheumatol. 2017;8(6):8–12.

Hazratwala K, Matthews B, Wilkinson M, Barroso-Rosa S. Total knee arthroplasty in patients with extra-articular deformity. Arthroplast Today. 2016;2(1):26–36.

Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res. 2016;28(1):1–15.

Rattanaprichavej P, Laoruengthana A. Total knee arthroplasty with extra- or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia: A report of three cases. J Orthop Surg. 2016;24(1):116–20.

Rajgopal A, Vasdev A, Dahiya V, Tyagi VC, Gupta H. Total knee arthroplasty in extra articular deformities: A series of 36 knees. Indian J Orthop. 2013;47(1):35–9.

Wang JW, Chen WS, Lin PC, Hsu CS, Wang CJ. Total knee replacement with intra-articular resection of bone after malunion of a femoral fracture: Can sagittal angulation be corrected? J Bone Jt Surg - Ser B. 2010;92(10):1392–6.

Mann JW, Insall JN, Scuderi GR. Total knee arthroplasty in patients with associated extra articular angular deformity. Orthop Trans. 1997;21:59.

Wolf AM, Hungerford DS, Pepe CL. The effect of extraarticular varus and valgus deformity on total knee arthroplasty. Clin Orthop Relat Res. 1991;271:35–51.

Wang JW, Wang CJ. Total knee arthroplasty for arthritis of the knee with extra-articular deformity. J Bone Jt Surg. 2002;84(10):1769–74.

de Pablos Fernández J, Arbeloa-Gutierrez L, Arenas-Miquelez A. One-stage total knee arthroplasty plus corrective osteotomy for osteoarthritis associated with severe extra-articular deformity. Arthrosc Tech. 2019;8(11):e1403–10.



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