Abstract
Severe varus deformity has no predilection for male or female patients. The patient usually has a history of bilateral varus alignment from childhood. The deformity gradually progresses. It may manifest with significant symptoms at any time, but often after 50 years of age. Tibial deformity is responsible for the varus angulation. The medial tibial plateau is deficient. The tibia is often partially dislocated laterally. An initial medial collateral ligament (MCL) release should be performed during exposure by dissecting the deep MCL off the proximal medial tibia while gaining exposure and resecting any tibial or femoral osteophytes that tent up the MCL. In very severe deformity, an initial tibial bone resection should be performed. The tibial tray size is then determined, undersized, and shifted laterally. Uncapped medial tibial bone is then resected to gain more medial release. A formal MCL subperiosteal release from the tibia is rarely necessary.
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