I AM DOING A TOTAL KNEE IN A PATIENT WITH A VARUS DEFORMITY. I HAVE DONE MY STANDARD RELEASE AND THE KNEE IS STILL TIGHT MEDIALLY. WHAT SHOULD I DO?

Varus deformity accounts for approximately 85% of arthritic knee patterns. It is created by progressive loss of the medial articular cartilage and bone followed by progressive contracture of the medial soft tissues and, ultimately, attenuation of the lateral soft tissues. When preoperative standing films show lateral subluxation of the tibia on the femur, one should anticipate the need for more extensive releases and the possible need for a constrained implant. In addition, flexion contracture is often associated with varus deformity and must be dealt with concomitantly as an integrated part of the medial release.