nach oben

European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

01.02.2016 | Original Article • KNEE - ARTHROPLASTY

Lateral subvastus approach with tibial tubercle osteotomy for primary total knee arthroplasty: clinical outcome and complications compared to medial parapatellar approach

verfasst von: Susanne Langen, Sonja Gaber, Vilijam Zdravkovic, Karlmeinrad Giesinger, Bernhard Jost, Henrik Behrend

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 2/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The lateral subvastus approach (LSVA) with tibial tubercle osteotomy (TTO) is an alternative approach for total knee arthroplasty (TKA) in selected patients. The aim of this study was to compare clinical outcomes between LSV and medial parapatellar approaches for primary TKA and to investigate incidence of complications related to TTO.

Methods

A total of 580 patients with primary TKA, meeting the inclusion criteria, were treated at our hospital from February 2006 until February 2013. All patients’ data were included in the local arthroplasty register and were followed up 12 months postoperatively. The data set contains: demographic data, the WOMAC score, the KSS as well as knee flexion and complications related to tibial tubercle osteotomy.

Results

The clinical outcome after TKA using the LSVA combined with TTO was comparable with those using the medial standard approach 1 year postoperatively. Four patients (3.8 %) needed a revision due to complications related to tubercle osteotomy.

Conclusions

The LSVA is thus a viable alternative in cases of primary TKA if technical difficulties with the medial approach are anticipated. Applying precise surgical technique, the LSVA seems to be a safe and reproducible procedure.

Baumann C, Rat A, Osnowycz G, Mainard D, Delagoutte J, Cuny C, Guillemin F (2006) Do clinical presentation and pre-operative quality of life predict satisfaction with care after total hip or knee replacement? J Bone Joint Surg 88(3):366–373. doi:10.1302/0301-620X.88B3.17025 CrossRef

Lingard E, Katz J, Wright E, Sledge C, Kinemax Outcomes G (2004) Predicting the outcome of total knee arthroplasty. J Bone Joint Surg 86-A(10):2179–2186PubMed

Gonzalez M, Mekhail A (2004) The failed total knee arthroplasty: evaluation and etiology. J Am Acad Orthop Surg 12(6):436–446PubMed

Sr Piedade, Pinaroli A, Servien E, Neyret P (2008) Tibial tubercle osteotomy in primary total knee arthroplasty: a safe procedure or not? Knee 15(6):439–446. doi:10.1016/j.knee.2008.06.006 CrossRef

Christian Z, Lukas L, van den Michel B, Peter N (2010) Tuberositas osteotomy for total knee arthroplasty: a review of the literature. J Knee Surg. doi:10.1055/s-0030-1267472

Hirschmann M, Hoffmann M, Krause R, Jenabzadeh R-A, Arnold M, Friederich N (2010) Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter? BMC Musculoskelet Disord 11:167. doi:10.1186/1471-2474-11-167 PubMedCentralCrossRefPubMed

Whiteside L, Ohl M (1990) Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res 260:6–9PubMed

Dolin M (1983) Osteotomy of the tibial tubercle in total knee replacement. A technical note. J Bone Joint Surg 65(5):704–706PubMed

Whiteside L (1995) Exposure in difficult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res 321:32–35PubMed

10.

Hay G, Kampshoff J, Kuster M (2010) Lateral subvastus approach with osteotomy of the tibial tubercle for total knee replacement: a two-year prospective, randomised, blinded controlled trial. J Bone Joint Surg 92(6):862–866. doi:10.1302/0301-620x.92b6.24027 CrossRef

11.

Arnold M, Friederich N, Widmer H (1999) Lateraler Zugang zum Kniegelenk mit Osteotomie der Tuberositas tibiae. Oper Orthop Traumatol 11(3):223–232CrossRef

12.

Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg 87(Suppl 1 Pt 2):271–284. doi:10.2106/JBJS.E.00308 PubMed

13.

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMed

14.

Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed

15.

Impellizzeri FM, Mannion AF, Leunig M, Bizzini M, Naal FD (2011) Comparison of the reliability, responsiveness, and construct validity of 4 different questionnaires for evaluating outcomes after total knee arthroplasty. J Arthroplasty 26(6):861–869. doi:10.1016/j.arth.2010.07.027 CrossRefPubMed

16.

Burki H, von Knoch M, Heiss C, Drobny T, Munzinger U (1999) Lateral approach with osteotomy of the tibial tubercle in primary total knee arthroplasty. Clin Orthop Relat Res 362:156–161CrossRefPubMed

17.

Halder A (2012) Tibial tubercle osteotomy. Operative Orthop Traumatol 24(2):85–94. doi:10.1007/s00064-011-0079-x CrossRef

18.

Nikolopoulos D, Polyzois I, Apostolopoulos A, Rossas C, Moutsios-Rentzos A, Michos I (2011) Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy. ESSKA 19(11):1834–1842. doi:10.1007/s00167-011-1474-4

19.

Karachalios T, Sarangi PP, Newman JH (1994) Severe varus and valgus deformities treated by total knee arthroplasty. J Bone Joint Surg 76(6):938–942

20.

Young C, Bourne R, Rorabeck C (2008) Tibial tubercle osteotomy in total knee arthroplasty surgery. J Arthroplasty 23(3):371–375. doi:10.1016/j.arth.2007.02.019 CrossRefPubMed

21.

Stern SH, Moeckel BH, Insall JN (1991) Total knee arthroplasty in valgus knees. Clin Orthop Relat Res 273:5–8PubMed

22.

Apostolopoulos A, Nikolopoulos D, Polyzois I, Nakos A, Liarokapis S, Stefanakis G, Michos I (2010) Total knee arthroplasty in severe valgus deformity: interest of combining a lateral approach with a tibial tubercle osteotomy. OTSR 96(7):777–784. doi:10.1016/j.otsr.2010.06.008 PubMed

23.

Chalidis BE, Ye K, Sachinis NP, Hawdon G, McMahon S (2013) Lateral parapatellar approach with tibial tubercle osteotomy for the treatment of non-correctable valgus knee osteoarthritis: a retrospective clinical study. Knee. doi:10.1016/j.knee.2013.05.008 PubMed

24.

O’Connor MI (2011) Implant survival, knee function, and pain relief after TKA: are there differences between men and women? Clin Orthop Relat Res 469(7):1846–1851. doi:10.1007/s11999-011-1782-5 PubMedCentralCrossRefPubMed

25.

Keblish P (1991) The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res 271:52–62PubMed

26.

Ritter M, Carr K, Keating E, Faris P, Meding J (1996) Tibial shaft fracture following tibial tubercle osteotomy. J Arthroplasty 11(1):117–119. doi:10.1016/s0883-5403(96)80171-9 CrossRefPubMed

27.

Ries M, Richman J (1996) Extended tibial tubercle osteotomy in total knee arthroplasty. J Arthroplasty 11(8):964–967. doi:10.1016/s0883-5403(96)80138-0 CrossRefPubMed

28.

Davis K, Caldwell P, Wayne J, Jiranek W (2000) Mechanical comparison of fixation techniques for the tibial tubercle osteotomy. Clin Orthop Relat Res 380:241–249CrossRefPubMed

29.

Wishart M, Arnold M, Huegli R, Amsler F, Friederich N, Hirschmann M (2012) Anterolateral approach using tibial tubercle osteotomy for total knee arthroplasty: can we predict failure? Int Orthop 36(12):2485–2490. doi:10.1007/s00264-012-1693-4 PubMedCentralCrossRefPubMed

Titel: Lateral subvastus approach with tibial tubercle osteotomy for primary total knee arthroplasty: clinical outcome and complications compared to medial parapatellar approach
verfasst von: Susanne Langen
Sonja Gaber
Vilijam Zdravkovic
Karlmeinrad Giesinger
Bernhard Jost
Henrik Behrend
Publikationsdatum: 01.02.2016
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 2/2016
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-015-1718-y

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Lateral subvastus approach with tibial tubercle osteotomy for primary total knee arthroplasty: clinical outcome and complications compared to medial parapatellar approach