Background Up to 12 % of primary total knee arthroplasties (TKA) may be complicated by an extraarticular deformity, which creates special difficulties for acquiring the best possible alignment and ligament balance. Case A 60-year-old woman with end-stage tricompartmental osteoarthritis and 12° proximal-third tibial varus malunion underwent single-stage TKA along with metaphyseal open-wedge tibial osteotomy stabilized with a long, uncemented stem spanning the osteotomy site. Outcomes The osteotomy healed radiographically at six weeks. The mechanical hip-knee-ankle axis normalized to neutral, the range of motion was improved to 0–130°, and the Knee Society Score rose from 54 before surgery to 92 at four months. Nine months postoperatively, the patient was walking unlimited distances without assistance and had a KOOS Jr score of 90. There were no complications. Conclusion A metaphyseal tibial osteotomy stabilized only by the TKA stem may allow immediate weight bearing, early union, and good short-term function, indicating that rigid angular criteria for selecting the site of extraarticular correction may be too conservative.
Farahani et al. (2026) studied this question.