Problem case 6, primary varus G. Yavari

History 69 years old female Bilateral knee pain since 15 years ago Hx.of asthma & hypertension Corticosteroid use for asthma

Physical exam Bilateral knees severe varus deformity(L>R) Bilateral knees severe varus thrust Bilateral full ROM

Lab tests Normal lab tests

Pre-op radiographs

Pre-op radiographs

Alignment( left knee) MF-MT 26 ˚ MF-AF 7 ˚ MLDFA 92 ˚ MMPTA 74 ˚ CA 6 ˚

Questions 1. Where is the deformity? 2. Which prosthesis do you choose? 3. Which approach do you select?

Questions 4. How much correction angle do you select for distal femoral cut? 5. How about rotation? 6. What do you do for soft tissue balancing?

Questions 7. How do you manage tibial bone defect? 8. What do you do to prevent relative joint line elevation? 9. What do you think about patella?

Technique distal femur cut 5 degree 2mm less cut on distal femur femur external rotation 3 degree Stage II medial release Downsizing & lateralization of tibia component Bone defect, screw & cement

Post- op radiographs

6 month post-op Mild anterior knee pain ROM 0-120 Normal alignment Stable knee