The lateral and medial approach in total arthroplasty for valgus knee: a meta-analysis of current literature

Xu, Ge‐Liang; Fu, Xin; Tian, Peng; Bahat, Daniel; Huang, Yuting; Li, Zhijun

doi:10.2217/cer-2019-0111

Cited by 9 publications

(13 citation statements)

References 27 publications

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“…Although there are several randomized controlled trials comparing the MPA, MV, SV, and LPA approaches, many are small in sample size, report mixed results, and have short follow-up duration. 16,17 We aimed to add to this body of literature by reporting outcomes of a singlesurgeon, expertise-based study. The MV approach for TKA was first described as a modification of the SV approach to allow for easier expos ure.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis also compared the LPA to the MPA for valgus knees and found improved KSS in the LPA group, but similar alignment, operative duration, blood loss, WOMAC scores, postoperative pain, and ROM between the 2 approaches. 16 As the LPA is commonly described for valgus knees, allowing for direct access to the tight lateral structures, our analysis for this group involved only knees with valgus preoperative alignment. Our comparison of the MPA and LPA in valgus knees actually showed significantly lower SF-12 PCS (p = 0.011) and WOMAC function scores (p = 0.022) at 1 year postoperative for the LPA group.…”

Section: Table 2 Outcome Scores In Medial Parapatellar and Subvastus Approach Patients Up To 2 Years Postoperativementioning

confidence: 99%

“…Nonetheless, several studies have reported promising outcomes with this approach in valgus knees. 15,16 Given the small sample size and mixed results of existing studies, we aimed to add to the body of literature by retrospectively reviewing patients at our institution and comparing outcomes of the SV, MV, and LPA to the standard MPA.…”

mentioning

confidence: 99%

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Does surgical approach affect patient outcomes of total knee arthroplasty?

Sidhu¹,

Somerville²,

Sidhu³

et al. 2021

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Does surgical approach affect patient outcomes of total knee arthroplasty?Background: Surgical approaches for total knee arthroplasty (TKA) include the medial parapatellar (MPA), subvastus (SV), midvastus (MV), and lateral parapatellar approach (LPA); it remains unclear which approach is superior.Methods: Patients having undergone TKA at our institution were retrospectively organized into matched groups according to surgical approach (MPA, MV, SV, or LPA). Outcomes between the groups were compared using the Short-Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and range of motion (ROM) up to 2 years postoperative.Results: Sixty-eight MV patients, 8 SV patients, and 4 LPA patients were matched with groups of MPA patients. There was no difference in outcomes between the MPA and MV groups up to 2 years. The SV group had significantly higher SF-12 Physical Composite Score (PCS; p = 0.036) and WOMAC stiffness score (p = 0.014) at 2 years, but significantly lower flexion at 1 year (p = 0.022) than the MPA group. The LPA group had significantly lower SF-12 PCS (p = 0.011) and WOMAC function scores (p = 0.022) at 1 year than the MPA group. Conclusion:There was no significant difference between the MPA and MV approach. The SV approach had some improved long-term outcomes over the MPA aproach (SF-12 and WOMAC), but had significantly lower flexion at 1 year. The LPA group showed inferior outcomes than the MPA group but had more severe valgus preoperative deformity (p = 0.024). Further studies are required to investigate the potential benefit of quadriceps-sparing approaches.Contexte : Les voies chirurgicales d'arthroplastie totale du genou (ATG) sont les suivantes : parapatellaire interne (PI), subvastus (SV), midvastus (MV), et parapatellaire externe (PE); il n'est pas clair quelle voie est supérieure.Méthodes : Les patients qui ont subi une ATG dans notre établissement ont été classés rétrospectivement en groupes appariés selon la voie chirurgicale (PI, MV, SV ou PE). Les résultats des différents groupes ont été comparés au moyen du Short-Form 12 (SF-12), de l'indice Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), du score de la Knee Society (KSS) et de l'amplitude du mouvement jusqu'à 2 ans après l'opération.Résultats : Au total, 68 patients traités par voie MV, 8 par voie SV et 4 par voie PE ont été appariés avec des groupes de patients traités par voie PI. Il n'y avait aucune différence dans les résultats entre les groupes PI et MV jusqu'à 2 ans. Comparativement au groupe PI, le groupe SV avait des résultats significativement plus élevés pour le score physique fonctionnel (PCS) du SF-12 (p = 0,036) et le score de raideur de l'indice WOMAC (p = 0,014) après 2 ans, mais une flexion significativement plus faible après 1 an (p = 0,022). Encore comparativement au groupe PI, le groupe PE avait des résultats significativement plus faibles pour le PCS du SF-12 (p = 0,011) et les scores fonctionnels de l'indice WOMAC (p = 0,022) après 1 a...

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Section: Discussionmentioning

confidence: 99%

Section: Table 2 Outcome Scores In Medial Parapatellar and Subvastus Approach Patients Up To 2 Years Postoperativementioning

confidence: 99%

See 1 more Smart Citation

Does surgical approach affect patient outcomes of total knee arthroplasty?

Sidhu¹,

Somerville²,

Sidhu³

et al. 2021

cjs

View full text Add to dashboard Cite

show abstract

“…The remainder of the issue includes a range of surgically related research. In their paper, Li et al compare lateral and medial approaches of total knee arthroplasty (TKA) in the valgus knee, a deformity found in around 10-15% of TKA patients [3]. Ni et al also compare surgical techniques; in their paper they look at the comparative clinical and radiographic outcomes of two types of minimally invasive surgery for degenerative spondylolisthesis: transforaminal lumbar interbody fusion and oblique lumbar interbody fusion [4].…”

Section: In This Issuementioning

confidence: 99%

Introducing Volume 9 of the Journal of Comparative Effectiveness Research

Dormer

2020

J. Comp. Eff. Res.

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“…Total knee arthroplasty (TKA) has become the most effective method for the treatment of end-stage knee joint diseases [1]. Valgus knee deformity (≥ 10°) is observed in nearly 10% of patients who underwent TKA [2]. Valgus knee deformity is a challenge in TKA because the soft tissue release and balancing are crucial for long-term success [3].…”

Section: Introductionmentioning

confidence: 99%

Posteromedial Corner Release with the Knee in Figure-of-Four Position vs Conventional Position for Varus Knee Arthroplasty

Zheng

et al. 2020

Preprint

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Backgroud: The objective of this study is to introduce posteromedial corner release with the knee in the figure-of-four position versus the conventional position for varus knee arthroplasty. Methods : From March 2015 to September 2019, 123 patients (139 knees) with varus knee were randomly and blindly allocated to experimental group (60 patients; 68 knees) and control group (57 patients; 65 knees). Patients in experimental group underwent posteromedial corner release with the knee in the figure-of-four position; and patients in control group with the knee in the conventional position. Time for soft tissue balancing was defined as the time from the start of spacer test to the end of balance test. Length of release was defined as the distance from the osteotomy surface of the tibial plateau to the farthest structures released. The rating system of Hospital for Special Surgery (HSS) knee score was used to evaluate the clinical results. Differences were considered statistically significant at p < 0.05. Results: The mean time for soft tissue balancing was 8.4±3.3 minutes and 8.4±3.3 minutes in experimental and control group, respectively ( p <0.05). The mean length of releasing posteromedial corner structures was 35.5±13.4 mm and 27.3±9.7 mm in experimental and control group, respectively ( p <0.05). HSS scores 5 years after surgery were 95.1±16.9 and 94.8±17.2 respectively ( p >0.05). Conclusion: During varus knee arthroplasty, the posteromedial corner can be released more extensively and thoroughly when the knee is placed in the figure-of-four position.

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The lateral and medial approach in total arthroplasty for valgus knee: a meta-analysis of current literature

Cited by 9 publications

References 27 publications

Does surgical approach affect patient outcomes of total knee arthroplasty?

Does surgical approach affect patient outcomes of total knee arthroplasty?

Introducing Volume 9 of the Journal of Comparative Effectiveness Research

Posteromedial Corner Release with the Knee in Figure-of-Four Position vs Conventional Position for Varus Knee Arthroplasty

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