lateral release: but bad structures for release which may be weak or loose and lead to lateral instability in flexion

resect more medial plateau DANGER of subsequent medial instability!

in flexion:• femoral rotation unchanged• patella : OK• but lateral structures are elongated and

weak and there is a danger of overstretching and of rotating the femoral implant to obtain stability.

So, with such a knee:So, with such a knee: in flexion: use the transepicondylar line as in flexion: use the transepicondylar line as

a guide to be parallel with the AP cutsa guide to be parallel with the AP cuts use a constrained design for small use a constrained design for small

deformitydeformity

Or, you may:Or, you may: Want to keep the lateral structures strongWant to keep the lateral structures strong use lateral condyle osteotomy use lateral condyle osteotomy ????????

(not an excellent indication)(not an excellent indication)

But, if the deformity is more But, if the deformity is more important > 8-10°important > 8-10°

Concomitant tibial Concomitant tibial metaphysealmetaphyseal osteotomyosteotomy- Medial closing wedgeMedial closing wedge- Lateral opening wedgeLateral opening wedge

Opening wedgeOpening wedge

192°192°

Tibia valgumTibia valgum

Watch out !

180°180°

and then …Closing wedgeand then …Closing wedgeIA surgery

4th MESSAGE4th MESSAGE

Femoral deformitiesFemoral deformities are more are more difficult than tibial deformities difficult than tibial deformities

Because their correction influences both Because their correction influences both extension & flexion gapextension & flexion gap

Femur varum ++++Femur varum ++++

Valgum deformitiesValgum deformities are difficult are difficult due to release technique and risk of due to release technique and risk of instabilityinstability

60 y old60 y old

Femur varumFemur varum

+ malunion in IR+ malunion in IR

163°163°

IA surgeryIA surgery

+ femoral + femoral osteotomyosteotomy

Gosse 162Gosse 162182182

scan: +15 –15°scan: +15 –15°

162°162°

MalunionMalunion

Supracondylar FxSupracondylar Fx

67 Y67 Y

Retroversion: 14°Retroversion: 14° Anteversion: 15°Anteversion: 15°

29° Internal Rotation

182°182°

If you want to achieve correct surgery:If you want to achieve correct surgery: