Publication:

Optimizing soft tissue balance through medial tibial reduction osteotomy in tight varus deformity during total knee replacement

Background Achieving appropriate soft-tissue balance during total knee replacement (TKR) in varus deformities is essential to prevent instability and optimize surgical outcomes. Medial tibial reduction osteotomy (MTRO) serves as a bony technique to reduce the need for extensive medial soft-tissue release in knees with tight varus deformity.

Methods This prospective clinical study involved patients with osteoarthritic knees and significant varus malalignment scheduled for TKR. After initial bone cuts, persistent medial tightness prompted MTRO by removing a portion of the medial tibial plateau. The extent of resection was guided by intraoperative gap balancing aiming for equalized flexion and extension gaps. Deformity correction was assessed using clinical examination and postoperative radiographs. Functional outcomes were measured via the Knee Society Score (KSS) preoperatively and at follow-up.

Results Fifty knees underwent MTRO with an average medial bone resection of 7.4±2 mm, resulting in an average varus correction of 3.4°±1°. A positive correlation was noted between the degree of osteotomy and varus correction, especially in knees with deformities less than 15°. MTRO effectively enabled balanced joint gaps without extensive medial ligament release. Mean KSS improved significantly from 47±9 before surgery to 93±3 postoperatively. There were no increased rates of complications or joint instability.

Conclusions MTRO is a valuable adjunct technique for correcting deformity and balancing soft tissues in tight varus knees during TKR, yielding favorable clinical results and minimal complications.