To compare the surgical outcomes of patients treated with different degrees of knee varus utilizing the pie-crusting technique in total knee arthroplasty (TKA).

The patients with end-stage knee osteoarthritis (KOA) who underwent TKA at the Joint Surgical Department of Zhoukou Orthopaedic Hospital in recent years were reviewed. They were divided into the severe varus group and the non-severe varus group according to whether the knee varus angle exceeded 20 degrees. The t test was performed for joint mobility (ROM), American Knee Society (KSS) score, hip knee ankle (HKA). The complications were recorded.

A total of 37 subjects were included and followed up for 26 to 68 months. There were 21 cases in the severe varus group and 16 cases in the non-severe varus group. There was no significant difference in age(t=0.231), gender(χ²=27.493) or body mass index (BMI)( t=-1.279) between the two groups (P> 0.05). The preoperative ROM(t=-7.323), KSS score(t=-2.407) and HKA angle(t=5.654) of knee joint in severe varus group were significantly worse than those in non-severe varus group (P< 0.05). After TKA, the knee ROM(t=1.381), KSS score(t=-1.093) and HKA angle(t=1.458) of the two groups were improved, yet the difference between the two groups was not statistically significant (P> 0.05). Postoperative periprosthetic fracture occurred in one case (2.7%), which was bony union after open reduction and internal fixation. Skin redness and swelling occurred in 1 case (2.7%) and was wet applied with Iodophor gauze, and stitches were removed 2 weeks after operation. The patient was followed up for 58 months, during which no periprosthetic infection occurred. Aseptic loosening occurred in one case (2.7%), and condylar limited prosthesis was used for revision.

Using "pie-crusting" technique and comprehensive method to deal with soft tissue balance in TKA can make patients with different degrees of knee varus and flexion deformity obtain good postoperative effect.