Total knee arthroplasty, following application of Taylor Spatial Frames to treat knee osteoarthritis with severe tibia extraarticular deformity due to fracture malunion: A case report

Obtaining alignment during end-stage knee osteoarthritis with extraarticular deformities has always been challenging. Therefore, we report a case of total knee arthroplasty, following the application of Taylor Spatial Frame to treat knee osteoarthritis with severe tibia extraarticular deformity due to a proximal tibia fracture injury for more than 50 years ago. First, proximal tibial opening wedge osteotomy was conducted below the patellar tendon insertion from the anterior to the posterior direction to correct the deformity in multiple planes gradually. Then, osteotomy was done to restore both the varus and recurvatum deformities. Finally, Taylor Spatial Frame was used as a virtual hinge, with gradual adjustments to correct the deformity. Afterward, patient-specific instrumentation-assisted total knee arthroplasty was conducted after correcting the extraarticular deformity. During the two-year follow-up, no superficial and deep infection occurred, and his Oxford Knee Score had improved from 32 to 19 out of 48 at the time of the latest follow-up. Moreover, the patient walked using a one-hand clutch without protective limping. Hence, patient-specific instrumentation-assisted total knee arthroplasty, following proximal tibial osteotomy with Taylor Spatial Frame, should be considered a treatment option for patients with knee osteoarthritis having severe proximal tibia extraarticular deformity.