A painful arthritic knee with severe valgus deformity may be treated successfully with total knee arthroplasty using several techniques: constrained implant with lateral release, non-constrained implant with lateral release and a thick tibial insert, or nonconstrained implant with lateral release and medial reconstruction. Eight patients with Type II valgus deformity were treated with nonconstrained total knee arthroplasty implants, lateral ITB release at the level of the tibial osteotomy, and proximal medial collateral ligament advancement with bone plug recession. The reconstruction led to predictably successful outcomes in all patients at 4- to 9-years followup. All patients were satisfied with the operation. All knees were stable with a functional range of motion at the time of last followup.