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PURPOSE
The study reports the 2-year follow-up results of patients with valgus osteoarthritis undergoing total knee arthroplasty (TKA) with a standardized soft-tissue release.

METHODS
Between 2008 and 2013, 222 TKAs were performed for valgus osteoarthritis by a single surgeon. A total of 181 TKAs in 164 patients were available for a minimum 2-year follow-up (range 24-87 months). Preoperative and postoperative range of motion (ROM), mechanical alignment, the postoperative medial proximal tibial angle (MPTA), Western Ontario and McMaster Universities Arthritis Index (WOMAC), VF-12 score, visual analogue pain scale (VAS), and the actual UCLA activity score, desired UCLA score, ligamentous stability (medial collateral ligament) and complications and revision rates were recorded.

RESULTS
The ROM increased from a preoperative flexion contracture of 4.7° (range 0-40) and flexion of 110° (range 35-135) to a postoperative mean flexion contracture of 0.1° (range -5 to 10) and flexion of 128° (range 100-140). The mean hip-knee-ankle alignment was changed from 8.4° of mechanical valgus (range 5.3-25.4) to 0.02° of varus alignment (range -2.9 to 4.1). Tibia component angle (MPTA) was 90.4° (range 86.1-93.7). The WOMAC score, VF-12, UCLA and VAS significantly improved after surgery (p < 0.05). Two patients (1.1 %) underwent revision surgery for instability.

CONCLUSION
The described standardized soft-tissue release (release of the iliotibial band and posterolateral corner) provided excellent clinical results at a minimum 2-year follow-up and can be used safely for a "cook-book" approach to the valgus knee with up to 25° mechanical valgus alignment.

LEVEL OF EVIDENCE
IV.