[Total knee arthroplasty by lateral parapatellar approach for valgus knee]

Dian-ge Zhou, Bin Zhang, Bo-long Kou, Hou-shan Lü
Zhonghua Yi Xue za Zhi [Chinese medical journal] 2007 July 17, 87 (27): 1885-9

OBJECTIVE: To investigate the effect of lateral parapatellar approach in total knee arthroplasty (TKA) of valgus knee.

METHODS: Lateral parapatellar approach of total knee arthroplasty was applied in 8 patients (10 knees) with severe valgus osteoarthritis knee (bilateral in 2 cases and unilateral in 6 cases), with the valgus angle > 15 degrees , 1 male (1 knee) and 7 females (9 knee), aged 68.2 (58 - 79), 7 cases (9 knees) being of the Krackow type I and 1 case (1 knee) of the Krackow type I, I. After incision of the skin through lateral knee, ilio-tibial band was prolonged by apple pie arthroplasty. The joint capsule was cut open laterally 2 - 4 cm from the para-patellar edge. Soft tissue balance was performed by releasing I - T band in Gerdy tubercle, lateral collateral ligament and poster-lateral capsule from the femur and tibial side. Valgus angle of distal femur cutting were five degree. Whiteside line and trans-epicondylar line were used as AP rotational cutting reference. All patellar of the group were resurfaced. Capsule closure is completed with the knee flexed. The expanded deep lateral soft tissue sleeve (coronal Z-plasty) is sutured with the medial retinaculum sleeve (superficial layer). Follow-up was conducted for 19.6 months (1 - 51 months).

RESULTS: Seven cases (9 knees) were replaced by posterior stabilized cemented prostheses (TC-Dynamic, PLUS), one case (1 knee) was replaced by RT prosthesis (RT-PLUS(TM) Solution, PLUS). After operation, the valgus deformity of all patients was corrected and all patients could walk 100 m with or without the help of walking holders. The average range of motion (ROM) was improved from the pre-operative. 95.6 degrees (85 degrees - 110 degrees ) to the post-operative 117.1 degrees (100 degrees - 125 degrees ). The average femorotibial angle (FTA) was corrected from the pre-operative. 27.6 degrees (20 degrees - 40 degrees ) to the post-operative 6.8 degrees (5 degrees - 9 degrees ). The Knee Score System (KSS) score and functional score were improved from the pre-operative 22.7 points (9 - 48 points) and 26.5 points (12 - 55 points) to the post-operative 86.4 points (85 - 95 points) and 89.1 points (80 - 95 points) respectively. Follow-up showed that the FTA remained unchanged and the knee stability of all patients was good.

CONCLUSION: Through lateral approach, "Z" plasty of the capsule can release the lateral structure and decrease the pressure of common peroneal nerve. For TKR with moderate to severe fixed valgus knee, lateral approach is an effective way to correct the deformity.

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