Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee

Sekiya, Hiroo; Takatoku, Kenzo; Takada, Hisahi; Sugimoto, Naoya; Hoshino, Yuichi

doi:10.1007/s00590-012-1137-2

Cited by 41 publications

(39 citation statements)

References 18 publications

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“…The literature shows similar results between the two techniques in relation to the post-operative alignment in the coronal plane 17, 21, 22. Some studies point to a better postoperative range of motion using the lateral approach 21, 23.…”

Section: Discussionmentioning

confidence: 82%

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Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty

Filho

Passarelli

Brito

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo compare the clinical and radiological outcomes of conventional medial and lateral approaches for total knee replacement in the valgus osteoarthritic knee.MethodsIn this randomized controlled trial, 21 patients with valgus knee osteoarthritis were randomized to total knee replacement through medial or lateral approach. The primary outcome was radiographic patellar tilt. Secondary outcomes were visual analog scale of pain, postoperative levels of hemoglobin, and clinical aspect of the operative wound.ResultsThere were no differences between the groups regarding other clinical variables. Mean lateral tilt of the patella was 3.1 degrees (SD ± 5.3) in the lateral approach group and 18 degrees (SD ± 10.2) in the medial approach group (p = 0.02). There were no differences regarding the secondary outcomes.ConclusionLateral approach provided better patellar tilt following total knee replacement in valgus osteoarthritic knee.

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Section: Discussionmentioning

confidence: 82%

“…Some studies point to a better postoperative range of motion using the lateral approach 21, 23. Another advantage is the possibility of using common implants (non-constricted), while the knee valgus operated using medial access route tends to more often require implants with larger constriction 22 .…”

Section: Discussionmentioning

confidence: 99%

Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty

Filho

Passarelli

Brito

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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“…According to different authors [21], the main advantage of the lateral approach is a better visualisation of the tight lateral tissues; besides, if a lateral retinaculum release is necessary, the patellar vascularisation will be not compromised. On the other hand, potential disadvantages of this technique include difficulty in patellar eversion, sometimes requiring TTO, and less familiarity of many surgeons with this technique [22].…”

Section: Anterolateral Approachmentioning

confidence: 99%

“…Sekiya et al [21] reported on clinical and radiological results in two randomised groups of patients with a valgus deformity after performing a TKA. In the first group a medial parapatellar approach was used and in the second one a lateral parapatellar approach without TTO.…”

Section: Anterolateral Approachmentioning

confidence: 99%

Total knee arthroplasty in the valgus knee

Rossi¹,

Rosso

Cottino

et al. 2013

International Orthopaedics (SICOT)

141

136

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Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10 % of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.

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“…Sekiya et al [13] compared the medial and lateral approach in valgus knees from 6°to 24°in 48 knees. They found less invasiveness to the quadriceps muscle when using the lateral approach but no significant differences in alignment, surgical time and lateral laxity.…”

Section: Discussionmentioning

confidence: 99%

Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform

Mayr

Reinhold²,

Hube³

et al. 2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate laxity in knees with pre-operative (preop) valgus alignment compared to knees with pre-operative varus alignment after total knee arthroplasty (TKA). Methods This was a retrospective study including 81 patients, with six years follow-up, for pre-operative valgus-or varus alignment of the leg. All patients had been supplied with the same cruciate retaining (CR) TKA with rotating platform. Clinical findings were assessed by KSS, OKS and IKDC 2000 score. Rotational knee laxity was evaluated by a validated instrument (Laxitester®) with 2 Nm torque in 30°flex-ion. Collateral ligament laxity was tested manually in 30°f lexion with a bending moment of approximately5 Nm. Biomechanical results were compared to the contralateral side. Results Thirty-one patients had a preop valgus alignment of 8.96°and 50 patients a varus leg axis of 4.99°in the mean. In the preop valgus knees rotational analysis showed an increased laxity of 10.7°compared to preop varus knees (p=0.001). There was no significant difference in medial (valgus 2.6 mm, varus 2.5 mm) and lateral (valgus 2.8 mm, varus 2.7 mm) laxity. KSS and OKS showed no significant differences in the follow-up results. In the IKDC 2000 objective score 50 % of the preop varus knees and 25.8 % of the preop valgus knees were classified as nearly normal. The difference in the IKDC objective was highly significant (p<0.001). Conclusion Preop valgus knees show a significantly increased rotational laxity but no increased collateral ligament laxity compared to pre-operative varus knees six years after TKA with rotating platform. There is a significant difference in IKDC objective.

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Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee

Cited by 41 publications

References 18 publications

Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty

Keblish's lateral surgical approach enhances patellar tilt in valgus knee arthroplasty

Total knee arthroplasty in the valgus knee

Rotational laxity and collateral ligament laxity following total knee arthroplasty with rotating platform

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