In patients with valgus knee undergoing total knee arthroplasty, there are abnormalities of soft tissue and bone structure in varying degrees. Soft tissue abnormalities include lateral structural contracture and medial structural relaxation. Bone tissue abnormalities include lateral femoral condylar dysplasia, tibial plateau collapse, bone defect and patellar subluxation. When the distal femoral osteotomy is performed, the conventional osteotomy method should not be followed in order to avoid the incorrect alignment after the operation. After the extension osteotomy, further soft tissue release is needed to achieve a gap balance between flexion and extension. This article will review the latest research on total knee arthroplasty for valgus knee.