1. Problem case 6, primary varus
G. Yavari

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

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

4. Lab tests
Normal lab tests

5. Pre-op radiographs

6. Pre-op radiographs

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

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

9. 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?

10. 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?

11. 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

12. Post- op radiographs

13. 6 month post-op Mild anterior knee pain ROM 0-120 Normal alignment
Stable knee