Fixed-valgus deformity can be a challenging problem for the reconstructive surgeon. The normal knee is aligned with a femorotibial angle of 6 to 7 degrees of valgus, and the goals of knee replacement surgery include a painfree knee with normal alignment and functional range of motion. We believe a posterior-stabilized prosthesis with sacrifice of the PCL will provide more reliable results for most surgeons in the valgus knee. The surgical epicondylar axis provides a reliable and reproducible landmark for appropriate rotational alignment of the femoral component, whereas the less involved medial femoral condyle and tibial plateau should be used to reference the distal femoral and proximal tibial cuts. Soft tissue balance should be achieved without modification of bone cuts. Sequential releases should be reassessed intermittently with laminar spreaders or a tensor. Avariety of releases and sequences of release have been described, and our preferred method is described earlier in this chapter. Correctly balanced, 90 to 95% of patients with valgus deformity reportedly will have good or excellent results. Complications include peroneal nerve palsy, instability, and patellar maltracking.
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