Because of post traumatic mal union or constitutionnal intraosseous femoral or tibial deviation, an extra articular deformity may be present in patients requiring TKR. In those cases, recreation of the mechanical axis will affect the orientation of femoral or tibial bone cuts and soft tissue balance. In those important deformities, an extra articular correction may be necessary. Between 1998 and 2013 we performed 31 TKR associated with femoral (6 cases) or tibial (25 cases) osteotomy in one time surgery. This study was prospective and the patients were examinated at 1, 2, 5, 10 and 15 years for the first patients. There were 17 males (one bilateral case) and 13 females with a 63 years average age (from 29 to 79). The deformity was constitutionnal in 14 cases, post trauma in 9 cases, post osteotomy in 8 cases. The extra articular deformity was between 10° and 35°: 15 in varus, 11 in valgus, 2 multidirectionnal, 1 intraosseous flessum, 1 important translation and 1 rotational deformity. In all the cases we used a long stem implant in the osteotomized bone: an osteosynthesis was performed in 26 cases (7 plates, 19 stapples). A posterostabilised prosthesis was used in 28 patients, a CCK implant in 3. We studied pre and post operatively with a 3 to 17 years follow up, IKS scoring, knee motion, knee stability and radiologicaly, HKA, tibial and femoral mechanical angle. In the knees with a varus deformity the average HKA was 158° before surgery and 181 after osteotomy combinated with TKR. In the valgus cases, the average HKA was 198° pre and 179° post operatively. Complications consisted in 1 peroperative fracture, 1 extension lag of 15° and 1 hematoma.

TKR associated with osteotomy seems to be a possible alternative in patients with severe constitutional or post traumatic extra articular deformities after discussion of the other solutions: osteotomy and TKR in two times surgery (particulaly in young patients) or constraint TKR (rotating hinged implants) in patients over 80 years of age.

Introduction: In patients with gonarthrosis secondary to a femoral or a tibial mal union, the technical problems are different according to the localization and the importance of the deformity, the presence of boneless, the cutaneous and ligamenteous status and the degree of preoperative motion.

Material and Methods: Between 1995 and 2003, 34 TKR have been performed in patients with mal unions either post trauma (26 cases) either secondary to surgery (osteotomy with hypercorrection). There were 21 males and 13 females. The average age was 63 years (38 to 77) The mal union was localized to the femur (9 cases) or the tibia (23 cases) or to the both femur and tibia (2 cases). The deformity was variable : varus, valgus, flessum, recurvatum or rotationnal mal union. IKS scoring, HKA, MFA and MTA angles were evaluated pre and post operatively. 11 cases of intra articular mal unions, secondary to epiphyseal fractures were operated : a TKR posterostabilized (9 cases) or constrained (2 cases) was performed.

In the extra articular mal unions (23) the technique depended on the degre of intraosseous deformity : medial or lateral release or osteotomy performed when the intra osseous deformity was more than 10°. TKR was associated with an osteotomy in one time surgery in 5 femoral mal unions and 12 tibial deformities.

Results: The average follow up was 8 years (4 to 13 years). Complications consisted in 5 phlebitis, 2 superficial skin necrosis, 4 stiff knees (flexion less than 80°). There was no infection in this short serie. The average IKS score was 65 before and 163 after operation. The average flexion was 83° preoperatively and 98° after surgery. Average HKA angle was 167° pre and 182° post operatively in the varus deformities. In the valgus deformity it was 191° pre and 181° post surgery.

Discussion: Average IKS scoring is less good in post traumatic mal unions than in the habitual TKR specially because of the motion : the knee is often stiff preoperatively and remain often stiff postoperatively. A quadriceps release is sometimes indicated either during the TKR either in a second time. Constrained implants (constrained condylar knee or rotating hinge) are necessary in some cases of medial or lateral insuffisency of the collateral ligament.

Introduction: In patients with gonarthrosis secondary to a femoral or a tibial mal union, the technical problems are different according to the localization and the importance of the deformity, the presence of boneless, the cutaneous and ligamenteous status and the degree of preoperative motion.

Matériel et méthodes: Between 1995 and 2003, 34 TKR have been performed in patients with mal unions either post trauma (26 cases) either secondary to surgery (osteotomy with hypercorrection).

There were 21 males and 13 females. The average age was 63 years (38 to 77)

The mal union was localized to the femur (9 cases) or the tibia (23 cases) or to the both femur and tibia (2 cases). The deformity was variable : varus, valgus, flessum, recurvatum or rotationnal mal union. IKS scoring, HKA, MFA and MTA angles were evaluated pre and post operatively. 11 cases of intra articular mal unions, secondary to epiphyseal fractures were operated : a TKR posterostabilized (9 cases) or constrained (2 cases) was performed.

In the extra articular mal unions (23) the technique depended on the degre of intraosseous deformity : medial or lateral release or osteotomy performed when the intra osseous deformity was more than 10°. TKR was associated with an osteotomy in one time surgery in 5 femoral mal unions and 12 tibial deformities.

Results: The average follow up was 8 years (4 to 13 years). Complications consisted in 5 phlebitis, 2 superficial skin necrosis, 4 stiff knees (flexion less than 80°). There was no infection in this short serie. The average IKS score was 65 before and 163 after operation. The average flexion was 83° preoperatively and 98° after surgery. Average HKA angle was 167° pre and 182° post operatively in the varus deformities. In the valgus deformity it was 191° pre and 181° post surgery.

Discussion: Average IKS scoring is less good in post traumatic mal unions than in the habitual TKR specially because of the motion : the knee is often stiff preoperatively and remain often stiff postoperatively. A quadriceps release is sometimes indicated either during the TKR either in a second time. Constrained implants (constrained condylar knee or rotating hinge) are necessary in some cases of medial or lateral insufficiency of the collateral ligament.