Tibial Malunion Below a Total Knee Arthroplasty Treated with Acute Rotational Osteotomy

Torsional deformities of the lower extremities, the abnormal rotation of the bone about its longitudinal axis, can lead to poor gait biomechanics. Excessive external tibial torsion (extorsion or outward rotation) has been seen to decrease the ability of the soleus muscle to extend the knee and create undesirable knee joint accelerations (1). In the native knee, tibial fracture malunion has been associated with poor knee function and early knee arthritis (2). In the setting of total knee arthroplasty (TKA), malalignment leads to pain, poor functional outcomes, and possibly implant failure requiring revision (3, 4).