Total Knee Arthroplasty in Patients with Extra-articular Deformities (Challenges, Techniques, and Outcomes)

Azizi, Mohammad; Zarei, Hooshmand; Mahdavi, Mahyar; Moteshakereh, Seyed Mohammadmisagh; Nosratpour, Miad; Zaker Moshfegh, Mana; Mosleh, Hamidreza; Kazemi, Morteza

doi:10.22034/ijos.2026.243324

Total Knee Arthroplasty in Patients with Extra-articular Deformities (Challenges, Techniques, and Outcomes)

Document Type : Review

Authors

Mohammad Azizi

Hooshmand Zarei

Mahyar Mahdavi

Seyed Mohammadmisagh Moteshakereh

Miad Nosratpour

Mana Zaker Moshfegh

Hamidreza Mosleh

Morteza Kazemi

Bone Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10.22034/ijos.2026.243324

Abstract

Abstract
Performing total knee arthroplasty (TKA) in patients with extra-articular deformities presents complex and significant surgical challenges that can have both direct and indirect impacts on treatment outcomes. These deformities often require more meticulous planning and tailored surgical strategies to maintain biomechanical alignment of the joint and ensure optimal patient function. Among these strategies are intra-articular corrections and extra-articular osteotomies, with the choice depending on the specific characteristics of the patient and the severity of the deformity. In this context, advanced technologies such as computer-assisted surgery and robotic systems have emerged as innovative tools that enhance accuracy in surgical planning and execution, minimize the risk of surgical errors, and facilitate improved clinical outcomes. This article provides a comprehensive review of current best practices and emerging trends in managing TKA for patients with extra-articular deformities, while also emphasizing the importance of multidisciplinary preoperative planning, advanced imaging assessment, and patient-specific risk evaluation. It further discusses structured decision-making algorithms to guide the selection of appropriate corrective techniques, with careful attention to soft-tissue balance, implant positioning, and long-term stability. Collectively, these considerations aim to optimize functional outcomes, reduce complications, and improve implant longevity in this challenging patient population.

Keywords

Total knee arthroplasty

Knee

Osteotomy

outcomes

Subjects