Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2014

01.08.2014 | Knee

The minimally invasive far medial subvastus approach for total knee arthroplasty in valgus knees

verfasst von: Angelique Koninckx, Pierre-Emmanuel Schwab, Arnaud Deltour, Emmanuel Thienpont

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The lateral approach in the valgus knee asks for a lot of soft tissue releases during the arthrotomy. The hypothesis of this study was that the far medial subvastus approach could be used in valgus knees and would guarantee both functional and radiological good to excellent results.

Methods

This is a retrospective study on 78 patients (84 knees) undergoing primary total knee arthroplasty (TKA) for type I or II fixed valgus knees. The mean (SD) preoperative mechanical alignment was 187° (4°) HKA angle. Functional recovery, pain, tourniquet times, necessary soft tissue releases as well as radiological alignment were measured.

Results

The Knee Score improved significantly from 45 (10) to 90 (10) (P < 0.05) and the function score improved as well from 35 (20) to 85 (10) (P < 0.05). Flexion improved from 110° (10°) to 137° (8°). Hospital stay was 4 (1.2) days. Alignment was corrected to 181° (1.5°) HKA angle with a postoperative joint line shift of +2.8 (3.2) mm. No clinical instability, as evaluated by the senior author, or osteolytic lines was observed at minimal one-year radiological follow-up.

Conclusion

The far medial subvastus approach is an excellent approach to perform Krackow type I and II TKA with primary PS implants.

Level of evidence

IV.
Literatur
1.
Zurück zum Zitat Aglietti P, Lup D, Cuomo P, Baldini A, De Luca L (2007) Total knee arthroplasty using a pie-crusting technique for valgus deformity. Clin Orthop Relat Res 464:73–77PubMed Aglietti P, Lup D, Cuomo P, Baldini A, De Luca L (2007) Total knee arthroplasty using a pie-crusting technique for valgus deformity. Clin Orthop Relat Res 464:73–77PubMed
2.
Zurück zum Zitat Bassaine M, Jeanrot C, Gagey O, Huten D (2007) The composite meniscal-capsular-fat pad flap in a lateral approach to the fixed valgus knee: an anatomical study. J Arthroplasty 22:601–604PubMedCrossRef Bassaine M, Jeanrot C, Gagey O, Huten D (2007) The composite meniscal-capsular-fat pad flap in a lateral approach to the fixed valgus knee: an anatomical study. J Arthroplasty 22:601–604PubMedCrossRef
3.
Zurück zum Zitat Bellemans J, Vandenneucker H, Van Lauwe J, Victor J (2010) A new surgical technique for medial collateral ligament balancing: multiple needle puncturing. J Arthroplasty 25:1151–1156PubMedCrossRef Bellemans J, Vandenneucker H, Van Lauwe J, Victor J (2010) A new surgical technique for medial collateral ligament balancing: multiple needle puncturing. J Arthroplasty 25:1151–1156PubMedCrossRef
4.
Zurück zum Zitat Costa CR, Johnson AJ, Harwin SF, Mont MA, Bonutti PM (2013) Critical review of minimally invasive approaches in knee arthroplasty. J Knee Surg 26:41–50PubMedCrossRef Costa CR, Johnson AJ, Harwin SF, Mont MA, Bonutti PM (2013) Critical review of minimally invasive approaches in knee arthroplasty. J Knee Surg 26:41–50PubMedCrossRef
5.
Zurück zum Zitat Boyer P, Boublil D, Magrino B, Massin P, Huten D (2009) Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop 33:1577–1583PubMedCentralPubMedCrossRef Boyer P, Boublil D, Magrino B, Massin P, Huten D (2009) Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. Int Orthop 33:1577–1583PubMedCentralPubMedCrossRef
6.
Zurück zum Zitat Brihault J, Lautman S, Favard L, Burdin P (2002) Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. J Bone Joint Surg Br 84:1131–1137CrossRef Brihault J, Lautman S, Favard L, Burdin P (2002) Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. J Bone Joint Surg Br 84:1131–1137CrossRef
7.
Zurück zum Zitat Chou PH, Chen WM, Chen CF, Chiang CC, Liu CL, Chen TH (2012) Clinical comparison of valgus and varus deformities in primary total knee arthroplasty following midvastus approach. J Arthroplasty 27:604–612PubMedCrossRef Chou PH, Chen WM, Chen CF, Chiang CC, Liu CL, Chen TH (2012) Clinical comparison of valgus and varus deformities in primary total knee arthroplasty following midvastus approach. J Arthroplasty 27:604–612PubMedCrossRef
8.
Zurück zum Zitat Clarke HD, Fuchs R, Scuderi GR, Scott WN, Insall JN (2005) Clinical results in valgus total knee arthroplasty with the “pie crust” technique of lateral soft tissue releases. J Arthroplasty 20:1010–1014PubMedCrossRef Clarke HD, Fuchs R, Scuderi GR, Scott WN, Insall JN (2005) Clinical results in valgus total knee arthroplasty with the “pie crust” technique of lateral soft tissue releases. J Arthroplasty 20:1010–1014PubMedCrossRef
9.
Zurück zum Zitat Easley ME, Insall JN, Scuderi GR, Bullek DD (2000) Primary constrained condylar knee arthroplasty for the arthritic valgus knee. Clin Orthop Relat Res 380:58–64PubMedCrossRef Easley ME, Insall JN, Scuderi GR, Bullek DD (2000) Primary constrained condylar knee arthroplasty for the arthritic valgus knee. Clin Orthop Relat Res 380:58–64PubMedCrossRef
10.
Zurück zum Zitat Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS (2004) Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg 86A:2671–2676 Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS (2004) Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg 86A:2671–2676
11.
Zurück zum Zitat Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12PubMed Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12PubMed
12.
Zurück zum Zitat Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA (2012) Length-change patterns of the collateral ligaments after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:1349–1356PubMedCrossRef Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA (2012) Length-change patterns of the collateral ligaments after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:1349–1356PubMedCrossRef
13.
Zurück zum Zitat Girard J, Amzallag M, Pasquier G, Mulliez A, Brosset T, Gougeon F, Duhamel A, Migaud H (2009) Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res 95:260–266PubMedCrossRef Girard J, Amzallag M, Pasquier G, Mulliez A, Brosset T, Gougeon F, Duhamel A, Migaud H (2009) Total knee arthroplasty in valgus knees: predictive preoperative parameters influencing a constrained design selection. Orthop Traumatol Surg Res 95:260–266PubMedCrossRef
14.
Zurück zum Zitat Hadjicostas PT, Soucacos PN, Thielemann FW (2008) Computer-assisted osteotomy of the lateral femoral condyle with non-constrained total knee replacement in severe valgus knees. J Bone Joint Surg Br 90:1441–1445PubMedCrossRef Hadjicostas PT, Soucacos PN, Thielemann FW (2008) Computer-assisted osteotomy of the lateral femoral condyle with non-constrained total knee replacement in severe valgus knees. J Bone Joint Surg Br 90:1441–1445PubMedCrossRef
15.
Zurück zum Zitat Hay GC, Kampshoff J, Kuster MS (2010) Lateral subvastus approach with osteotomy of the tibial tubercle for total knee replacement: a two-year prospective, randomized, blinded controlled trial. J Bone Joint Surg Br 92:862–866PubMedCrossRef Hay GC, Kampshoff J, Kuster MS (2010) Lateral subvastus approach with osteotomy of the tibial tubercle for total knee replacement: a two-year prospective, randomized, blinded controlled trial. J Bone Joint Surg Br 92:862–866PubMedCrossRef
16.
Zurück zum Zitat Healy WL, Iorio R, Lemos DW (1998) Medial reconstruction during total knee arthroplasty for severe valgus deformity. Clin Orthop Relat Res 356:161–169PubMedCrossRef Healy WL, Iorio R, Lemos DW (1998) Medial reconstruction during total knee arthroplasty for severe valgus deformity. Clin Orthop Relat Res 356:161–169PubMedCrossRef
17.
Zurück zum Zitat Keblish PA (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 Keblish PA (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
18.
Zurück zum Zitat Keblish PA (2002) Alternate surgical approaches in mobile-bearing total knee arthroplasty. Orthopedics 25:257–264 Keblish PA (2002) Alternate surgical approaches in mobile-bearing total knee arthroplasty. Orthopedics 25:257–264
19.
Zurück zum Zitat Koskinen E, Remes V, Paavolainen P, Herilainen A, Sandelin J, Tallroth K, Kettunen J, Ylinen P (2011) Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9-years. Knee 18:145–150PubMedCrossRef Koskinen E, Remes V, Paavolainen P, Herilainen A, Sandelin J, Tallroth K, Kettunen J, Ylinen P (2011) Results of total knee replacement with a cruciate-retaining model for severe valgus deformity—a study of 48 patients followed for an average of 9-years. Knee 18:145–150PubMedCrossRef
20.
Zurück zum Zitat Krackow KA, Jones MM, Teeny SM, Hungerford DS (1991) Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res 273:9–18PubMed Krackow KA, Jones MM, Teeny SM, Hungerford DS (1991) Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res 273:9–18PubMed
21.
Zurück zum Zitat Lombardi AV Jr, Dodds KL, Berend KR, Mallory TH, Adams JB (2004) An algorithmic approach to total knee arthroplasty in the valgus knee. J Bone Joint Surg 86A:62–71 Lombardi AV Jr, Dodds KL, Berend KR, Mallory TH, Adams JB (2004) An algorithmic approach to total knee arthroplasty in the valgus knee. J Bone Joint Surg 86A:62–71
22.
Zurück zum Zitat Lombardi AV Jr, Berend KR (2006) Posterior cruciate ligament-retaining, posterior stabilized, and varus/valgus posterior stabilized constrained articulations in total knee arthroplasty. Instr Course Lect 55:419–427PubMed Lombardi AV Jr, Berend KR (2006) Posterior cruciate ligament-retaining, posterior stabilized, and varus/valgus posterior stabilized constrained articulations in total knee arthroplasty. Instr Course Lect 55:419–427PubMed
23.
Zurück zum Zitat Matsumoto T, Muratsu H, Kubo S, Mizuno K, Kinoshita K, Ishida K, Matsushita T, Sasaki K, Tei K, Takayama K, Sasaki H, Oka S, Kurosaka M, Kuroda R (2011) Soft tissue balance measurement in minimal incision surgery compared to conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:880–886PubMedCrossRef Matsumoto T, Muratsu H, Kubo S, Mizuno K, Kinoshita K, Ishida K, Matsushita T, Sasaki K, Tei K, Takayama K, Sasaki H, Oka S, Kurosaka M, Kuroda R (2011) Soft tissue balance measurement in minimal incision surgery compared to conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:880–886PubMedCrossRef
24.
Zurück zum Zitat McAuley JP, Collier MB, Hamilton WG, Tabaraee E, Engh GA (2008) Posterior cruciate-retaining total knee arthroplasty for valgus osteoarthritis. Clin Orthop Relat Res 466:2644–2649PubMedCentralPubMedCrossRef McAuley JP, Collier MB, Hamilton WG, Tabaraee E, Engh GA (2008) Posterior cruciate-retaining total knee arthroplasty for valgus osteoarthritis. Clin Orthop Relat Res 466:2644–2649PubMedCentralPubMedCrossRef
25.
Zurück zum Zitat Miyasaka KC, Ranawat CS, Mullaji A (1997) 10- to 20-year follow-up of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 345:29–37PubMedCrossRef Miyasaka KC, Ranawat CS, Mullaji A (1997) 10- to 20-year follow-up of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 345:29–37PubMedCrossRef
26.
Zurück zum Zitat Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y (2011) Clinical and radiographic outcomes of minimally invasive total knee arthroplasty through a lateral approach. Knee Surg Sports Traumatol Arthrosc 19:973–979PubMedCrossRef Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y (2011) Clinical and radiographic outcomes of minimally invasive total knee arthroplasty through a lateral approach. Knee Surg Sports Traumatol Arthrosc 19:973–979PubMedCrossRef
27.
Zurück zum Zitat Niki Y, Takeda Y, Kanagawa H, Iwamoto W, Matsumoto H, Enomoto H, Toyama Y, Suda Y (2012) Effect of four different surgical approaches on intra-operative joint gap in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:2026–2031PubMedCrossRef Niki Y, Takeda Y, Kanagawa H, Iwamoto W, Matsumoto H, Enomoto H, Toyama Y, Suda Y (2012) Effect of four different surgical approaches on intra-operative joint gap in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:2026–2031PubMedCrossRef
28.
Zurück zum Zitat Nikolopoulos DD, Polyzois I, Apostolopoulos AP, Rossas C, Moutsios-Rentzos A, Michos IV (2011) Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy. Knee Surg Sports Traumatol Arthrosc 19:1834–1842PubMedCrossRef Nikolopoulos DD, Polyzois I, Apostolopoulos AP, Rossas C, Moutsios-Rentzos A, Michos IV (2011) Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy. Knee Surg Sports Traumatol Arthrosc 19:1834–1842PubMedCrossRef
29.
Zurück zum Zitat Pang HN, Yeo SJ, Chong HC, Chin PL, Chia SL, Lo NN (2013) Joint line changes and outcomes in constrained versus unconstrained total knee arthroplasty for the type II valgus knee. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2390-6 PubMed Pang HN, Yeo SJ, Chong HC, Chin PL, Chia SL, Lo NN (2013) Joint line changes and outcomes in constrained versus unconstrained total knee arthroplasty for the type II valgus knee. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-013-2390-6 PubMed
30.
Zurück zum Zitat Rajgopal A, Dahiya V, Vasdev A, Kochhar H, Tyagi V (2011) Long-term results of total knee arthroplasty for valgus knees: soft-tissue release technique and implant selection. J Orthop Surg (Hong Kong) 19:60–63 Rajgopal A, Dahiya V, Vasdev A, Kochhar H, Tyagi V (2011) Long-term results of total knee arthroplasty for valgus knees: soft-tissue release technique and implant selection. J Orthop Surg (Hong Kong) 19:60–63
31.
Zurück zum Zitat Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg 87A:271–284 Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg 87A:271–284
33.
Zurück zum Zitat Selvarajah E, Hooper G (2009) Restoration of the joint line in total knee arthroplasty. J Arthroplast 24:1099–1102CrossRef Selvarajah E, Hooper G (2009) Restoration of the joint line in total knee arthroplasty. J Arthroplast 24:1099–1102CrossRef
34.
Zurück zum Zitat Teichtahl AJ, Physio B, Wluka AE, Cicuttini FM (2008) Frontal plane knee alignment is associated with a longitudinal reduction in patella cartilage volume in people with knee osteoarthritis. Osteoarthritis and Cartilage 16:851–854PubMedCrossRef Teichtahl AJ, Physio B, Wluka AE, Cicuttini FM (2008) Frontal plane knee alignment is associated with a longitudinal reduction in patella cartilage volume in people with knee osteoarthritis. Osteoarthritis and Cartilage 16:851–854PubMedCrossRef
35.
Zurück zum Zitat Thienpont E (2012) Prosthesis selection: choosing the right type of constraint. In: Parvizi J (ed) Principles and techniques in revision total knee arthroplasty. AAOS Monographs, 1st edn. Data Trace Publishing, Chicago, pp 29–39 Thienpont E (2012) Prosthesis selection: choosing the right type of constraint. In: Parvizi J (ed) Principles and techniques in revision total knee arthroplasty. AAOS Monographs, 1st edn. Data Trace Publishing, Chicago, pp 29–39
36.
Zurück zum Zitat Thienpont E (2012) Faster quadriceps recovery with the far medial subvastus approach in minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2215-z Thienpont E (2012) Faster quadriceps recovery with the far medial subvastus approach in minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-012-2215-z
37.
Zurück zum Zitat Tigani D, Sabbioni G, Ben Ayad R, Filanti M, Rani N, Del Piccolo N (2010) Comparison between two computer-assisted total knee arthroplasty: gap-balancing versus measured resection technique. Knee Surg Sports Traumatol Arthrosc 18:1304–1310PubMedCrossRef Tigani D, Sabbioni G, Ben Ayad R, Filanti M, Rani N, Del Piccolo N (2010) Comparison between two computer-assisted total knee arthroplasty: gap-balancing versus measured resection technique. Knee Surg Sports Traumatol Arthrosc 18:1304–1310PubMedCrossRef
38.
Zurück zum Zitat Verborgt O, Victor J (2004) Post impingement in posterior stabilized total knee arthroplasty. Acta Orthop Belg 70:46–50PubMed Verborgt O, Victor J (2004) Post impingement in posterior stabilized total knee arthroplasty. Acta Orthop Belg 70:46–50PubMed
39.
Zurück zum Zitat Whiteside LA (1993) Correction of ligament and bone defects in total arthroplasty of the severely valgus knee. Clin Orthop Relat Res 288:234–245PubMed Whiteside LA (1993) Correction of ligament and bone defects in total arthroplasty of the severely valgus knee. Clin Orthop Relat Res 288:234–245PubMed
40.
Zurück zum Zitat Whiteside LA (1999) Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res 367:130–140PubMedCrossRef Whiteside LA (1999) Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res 367:130–140PubMedCrossRef
Metadaten
Titel
The minimally invasive far medial subvastus approach for total knee arthroplasty in valgus knees
verfasst von
Angelique Koninckx
Pierre-Emmanuel Schwab
Arnaud Deltour
Emmanuel Thienpont
Publikationsdatum
01.08.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 8/2014
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2701-y

Weitere Artikel der Ausgabe 8/2014

Knee Surgery, Sports Traumatology, Arthroscopy 8/2014 Zur Ausgabe

Arthropedia

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

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

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