Abstract： Background Primary total knee arthroplasty (TKA) in severe valgus knees may prove challenging,and choice of implant depends on the severity of the valgus deformity and the extent of soft-tissue release.The purpose of this study was to review 8 to 11 years (mean,10 years) follow-up results of primary TKA for varient-Ⅲ valgus knee deformity with use of different type implants.Methods Between January 2002 and January 2005,20 women and 12 men,aged 47 to 63 (mean,57.19±6.08) years old,with varient-Ⅲ valgus knees underwent primary TKA.Of the 32 patients,37 knees had varient-Ⅲ deformities.Pie crusting was carefully performed with small,multiple inside-out incisions,bone resection balanced the knee in lieu of soft tissue releases that were not used in the series.Cruciate-retaining knees (Gemini MKⅡ,Link Company,Germany) were used in 13 knees,Genesis Ⅱ (Simth & Nephew Company,USA) in 14 knees,and hinged knee (Endo-Model Company,Germany) in 10 knees.In five patients with bilateral variant-Ⅲll TKAs,three patients underwent 1-stage bilateral procedures,and two underwent 2-stage procedures.All implants were cemented and the patella was not resurfaced.The Hospital for Special Surgery (HSS) knee score was assessed.Patients were followed up from 8 to 11 years.Results The mean HSS knee score were improved from 50.33±11.60 to 90.06±3.07 (P ＜0.001).The mean tibiofemoral alignment were improved from valgus 32.72°±9.68° pre-operation to 4.89°±0.90° post-operation (P ＜0.001).The mean range of motion were improved from 93.72°±23.69° pre-operation to 116.61±16.29° post-operation (P ＜0.001).No patients underwent revision.One patient underwent open reduction and internal fixation using femoral condylar plates for supracondylar femoral fractures secondary to a fall at three years.Three patients developed transient peroneal nerve palsies,which resolved within nine months.Two patients developed symptomatic deep vein thrombosis that was managed with rivaroxaban and thrombo-embolic deterrent stockings.There was no incidence of pulmonary embolism.Postoperative patient satisfaction was 80.7±10.4 points in the groups.Prosthetic survival rate was 100％ at mean 10 years postoperative.Conclusions Not only hinged implants can be successfully used in variant-Ⅲll valgus knees.As our results show,if proper ligament balancing techniques are used and proper ligament balance is attained,the knee may not require the use of a more constrained components.Our results also present alternative implant choices for severe knee deformities.