Genu Recurvatum in Total Knee Arthorplasty: A Review

Genu recurvatum is a rare knee deformity that can be linked with osteoarthritis. The main causes of this deformity include neuromuscular disorders, rheumatoid arthritis, inverted tibial slope, or conditions associated with coronal deformities such as genu valgum. In cases of end-stage knee osteoarthritis, total knee arthroplasty is the indicated management to reduce pain and improve functionality and quality of life. Genu recurvatum is associated with an imbalance in the flexion and extension gaps, which is why it is necessary to have important considerations in the preoperative evaluation, implant selection, and surgical technique. We conducted a review in electronic databases including MEDLINE, EMBASE, and LILACS from 1990 to June 28, 2023. Two authors independently reviewed the titles and abstracts to identify studies that met the inclusion criteria. Thirty-four literature sources were included to address our inquiries. Results are presented in a narrative format, focusing on the design and study population for each specific research question. Genu recurvatum is a rare knee deformity which needs special considerations. Accurate assessment of the deformity magnitude and quadriceps weakness is crucial during the preoperative evaluation. The choice of implant should be tailored to the individual patient’s characteristics. Surgical technique plays a critical role in achieving soft tissue and gap balance. Literature highlights an increased incidence of complications associated with this deformity, particularly in cases of poliomyelitis. Navigation and robotics offer promising alternatives to enhance surgical precision and appear to show a lower recurrence rate.