Total knee arthroplasty in combination with a one-stage tibial osteotomy: a technique for correction of a gonarthrosis with a severe (>15 degrees) tibial extra-articular deformity.

Patients with a gonarthrosis and an extra-articular axis deformity >/=15 degrees (Krackow type VI) were treated by an unconstrained total knee arthroplasty combined with a tibial osteotomy. This technique was applied to 10 patients with a Krackow type VI deformity. The knee score improved significantly (P<.005, Wilcoxon test) from 28 +/- 15.25 (SD) preoperatively to 80.60 +/- 15.94 postoperatively, and the function score improved significantly (P<.017, Wilcoxon test) from 46.50 +/- 8.83 preoperatively to 76.00 +/- 21.19 postoperatively. The axis was corrected to an alignment of 5 degrees to 10 degrees in 8 patients and to 0 degrees to 4 degrees in 2 patients according to the Knee Society score. There were no patella-related problems and no nonunions. The advantages of this procedure are the preservation of the stable collateral ligaments, the avoidance of problems associated with managing bone deficiencies, and a precise axis correction compared with conventional techniques.