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Total knee arthroplasty in valgus knees using minimally invasive medial-subvastus approach.

Shah NA, Jain NP - Indian J Orthop (2016 Jan-Feb)

Bottom Line: The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h.The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001).The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°-35°) to 5° (range 3°-9°) valgus (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India.

ABSTRACT

Background: An ideal approach for valgus knees must provide adequate exposure with minimal complications due to approach per se. Median parapatellar approach is most commonly used approach in TKA including valgus knees. A medial subvastus approach is seldom used for valgus knees and has definite advantages of maintaining extensor mechanism integrity and minimal effect on patellar tracking. The present study was conducted to evaluate outcomes of total knee arthroplasty (TKA) and efficacy of subvastus approach in valgus knees in terms of early functional recovery, limb alignment and complications.

Materials and methods: We retrospectively reviewed 112 knees with valgus deformity between January 2006 and December 2011. All patients were assessed postoperatively for pain using Visual Analog Scale (VAS) and quadriceps recovery in form of time to active straight leg raising (SLR) and staircase competency and clinical outcomes using American Knee Society (AKS) score and radiographic evaluation with average followup of 40 months (range 24-84 months).

Results: The mean VAS on postoperative day (POD) 1 and POD2 at rest was 2.73 and 2.39, respectively and after mobilization was 3.28 and 3.08, respectively (P < 0.001). The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h. The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001). The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°-35°) to 5° (range 3°-9°) valgus (P < 0.001).

Conclusions: Mini-subvastus quadriceps approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photograph showing L-shaped arthrotomy used for subvastus technique
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Figure 2: Intraoperative photograph showing L-shaped arthrotomy used for subvastus technique

Mentions: All surgeries were performed by senior author (NAS) using mini-subvastus approach without using pneumatic tourniquet. Tranexamic acid,23 15 mg/kg, was given 30 minutes prior to surgery and 2 doses 10 mg/kg were given 3 and 6 h postsurgery. A skin incision about 4 inches in length [Figure 1] was made slightly medial to the midline of the knee extending from the superior pole of patella to the tibial tubercle in 90° of flexion. Dissection was carried out until the extensor apparatus was exposed. Intraoperatively, saline adrenaline (1:300,000) was infiltrated into skin and subcutaneous tissue to reduce bleeding. Medial flap was raised to identify inferior margin of vastus medialis (VM). VM was bluntly dissected off the intermuscular septum. An L-shaped capsulotomy [Figure 2] made with horizontal limb of the L along the inferior margin of VM until the superior pole of patella and vertical limb of L was extended from here until tibial tubercle. The patella was displaced laterally to expose the suprapatellar synovium that was divided medially keeping the suprapatellar pouch intact [Figure 3].


Total knee arthroplasty in valgus knees using minimally invasive medial-subvastus approach.

Shah NA, Jain NP - Indian J Orthop (2016 Jan-Feb)

Intraoperative photograph showing L-shaped arthrotomy used for subvastus technique
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4759870&req=5

Figure 2: Intraoperative photograph showing L-shaped arthrotomy used for subvastus technique
Mentions: All surgeries were performed by senior author (NAS) using mini-subvastus approach without using pneumatic tourniquet. Tranexamic acid,23 15 mg/kg, was given 30 minutes prior to surgery and 2 doses 10 mg/kg were given 3 and 6 h postsurgery. A skin incision about 4 inches in length [Figure 1] was made slightly medial to the midline of the knee extending from the superior pole of patella to the tibial tubercle in 90° of flexion. Dissection was carried out until the extensor apparatus was exposed. Intraoperatively, saline adrenaline (1:300,000) was infiltrated into skin and subcutaneous tissue to reduce bleeding. Medial flap was raised to identify inferior margin of vastus medialis (VM). VM was bluntly dissected off the intermuscular septum. An L-shaped capsulotomy [Figure 2] made with horizontal limb of the L along the inferior margin of VM until the superior pole of patella and vertical limb of L was extended from here until tibial tubercle. The patella was displaced laterally to expose the suprapatellar synovium that was divided medially keeping the suprapatellar pouch intact [Figure 3].

Bottom Line: The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h.The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001).The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°-35°) to 5° (range 3°-9°) valgus (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India.

ABSTRACT

Background: An ideal approach for valgus knees must provide adequate exposure with minimal complications due to approach per se. Median parapatellar approach is most commonly used approach in TKA including valgus knees. A medial subvastus approach is seldom used for valgus knees and has definite advantages of maintaining extensor mechanism integrity and minimal effect on patellar tracking. The present study was conducted to evaluate outcomes of total knee arthroplasty (TKA) and efficacy of subvastus approach in valgus knees in terms of early functional recovery, limb alignment and complications.

Materials and methods: We retrospectively reviewed 112 knees with valgus deformity between January 2006 and December 2011. All patients were assessed postoperatively for pain using Visual Analog Scale (VAS) and quadriceps recovery in form of time to active straight leg raising (SLR) and staircase competency and clinical outcomes using American Knee Society (AKS) score and radiographic evaluation with average followup of 40 months (range 24-84 months).

Results: The mean VAS on postoperative day (POD) 1 and POD2 at rest was 2.73 and 2.39, respectively and after mobilization was 3.28 and 3.08, respectively (P < 0.001). The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h. The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001). The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°-35°) to 5° (range 3°-9°) valgus (P < 0.001).

Conclusions: Mini-subvastus quadriceps approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.

No MeSH data available.


Related in: MedlinePlus