Total Knee Arthroplasty in Patients with Distal Femoral Malunion: A Case Report

Paulus Ronald Hibono, Andito Wibisono


Background: Post-traumatic arthrosis can occur subsequent to fracture of the distal femur related to residual malalignment or direct intraarticular injury. The presence of extra articular deformities either in the femur or the tibia with arthritis of the knee makes total knee arthroplasty (TKA) technically demanding. We report our initial experience on such complex knee arthroplasty

Case Presentation: A 69-year-old female complained of progressive right knee pain, limited range of motion and obvious varus deformity of the right knee. She had a trauma history 13 years ago on femur side, operated and subsequent removal of implant 2 years after. Preoperative radiographs showed severe osteoarthritis on medial side and patellofemoral joint and malunion supracondylar and varus deformity. Total knee arthroplasty (TKA) was done using standard jig and equipment

Conclusion: Correction could be possible to perform in majority of TKA for extraarticular deformities with good preoperative planning and templating, intraarticular bone resection and good soft tissue balancing both in flexion and extension.


Total Knee Arthoplasty; Extra-articular; Deformity; Intraarticular resection;

Full Text:



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

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

Papadopoulos EC, Parvizi J, Lai CH, Lewallen DG. Total knee arthroplasty following prior distal femoral fracture. Knee. 2002;9(4):267–74

Chin PL, Yang KY, Yeo SF, Lo NN. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty. 2005;20(5):618–26

Mason JB, Fehring TK. Management of extra-articular deformity in total knee arthroplasty with navigation. In: Norman Scott W, editor. Insall& Scott surgery of the knee. 5th ed. Philadelphia: Elsevier; 2012. p. p1232–9

Armstrong L., Jiranek W.A. (2015) Complex Primary Total Knee Arthroplasty: Management of Extra-articular Deformity. In: Springer B., Curtin B. (eds) Complex Primary and Revision Total Knee Arthroplasty. Springer, Cham.

Rajgopal A, Vasdev A, Dahiya V, Tyagi VC, Gupta H. Total knee arthroplasty in extra articular deformities: A series of 36 knees. Indian Journal of Orthopaedics. 2013 Jan;47(1):35-39.

Xiao-Gang Z, Shahzad K, Li C. One-stage total knee arthroplasty for patients with osteoarthritis of the knee and extra-articular deformity. International Orthopaedics. 2012 Dec;36(12):2457-2463.

Marczk D, Snyder M, Sibiński M, et al. One-stage total knee arthroplasty with pre-existing fracture deformity: post fracture total knee arthroplasty. J Arthroplasty. 2014;29(11):2104–8

Lonner JH, Siliski JM, Lotke PA. Simultaneous femoral osteotomy and total knee arthroplasty for treatment of osteoarthritis associated with severe extra-articular deformity. J Bone Joint Surg Am. 2000 Mar;82(3):342-8.

Loures, F.B., Correia, W., Reis, J.H. et al. Outcomes after knee arthroplasty in extra-articular deformity. International Orthopaedics (SICOT) 43, 2065–2070 (2019).

Badhe, N.P., Forster, I.W. Single stage osteotomy and total knee arthroplasty for tibio-femoral malunion with osteoarthritis of the knee. Eur J Orthop Surg Traumatol 11, 177–181 (2001).

Fehring K Thomas. “Chapter 19 Total Knee Arthoplasty: Extra-Articular Deformity.” Advance Reconstruction Knee , edited by Daniel J Berry, Lieberman, Jay R, and Frederick M Azar American Academy of Orthopaedic Surgeons, 2018, pp. 157–169.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.