scholarly journals Lateral or medial approach for valgus knee in total knee arthroplasty - which one is better? A systematic review

2019 ◽  
Vol 47 (11) ◽  
pp. 5400-5413 ◽  
Author(s):  
Bin Wang ◽  
Dan Xing ◽  
Jiao Jiao Li ◽  
Yuanyuan Zhu ◽  
Shengjie Dong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Evaluation Method ◽  
Primary Total Knee Arthroplasty ◽  
Lateral Approach ◽  
Tibial Tubercle ◽  
Valgus Knee ◽  
Medial Approach ◽  
Knee Deformity ◽  
Total Knee

Objective To identify whether the medial or lateral approach is superior for patients with valgus knees undergoing primary total knee arthroplasty (TKA). Methods Studies evaluating the 2 approaches were sourced from the PUBMED, EMBASE, Web of Science, and OVID databases. The quality of included studies was assessed using a modified quality evaluation method, and differences between approaches were systematically reviewed. Results Seventeen observational studies were included. The studies were published between 1991 and 2016, and included 5 retrospective studies and 12 prospective studies. Sixteen evaluation methods for the study outcomes were identified. Twelve and eight complication types were identified by studies reporting the lateral and medial approaches for valgus knee, respectively. Several studies showed that pain scores and knee function were superior using a lateral approach. Conclusion The lateral approach (combined with a tibial tubercle osteotomy or proximal quadriceps snip) was more useful and safer than the medial approach in the treatment of severe uncorrectable valgus knee deformity in patients undergoing TKA. Most of the available evidence supports the use of a lateral approach provided that the surgeon is familiar with the pathological anatomy of the valgus knee.

scholarly journals The use of the constrained prosthesis in the difficult primary knee arthroplasty

2021 ◽  
Vol 64 (5) ◽  
pp. 11-15
Author(s):  
Vitalie Iacubitchii ◽  
◽  
Alexandru Betisor ◽  
Nicolae Erhan ◽  
◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Revision Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Bone Defects ◽  
Valgus Knee ◽  
Total Knee ◽  
Primary Total Knee

Background: The constrained knee prosthesis has the basic indication in revision arthroplasty, but the latest literature reveals that it takes place also in primary total knee arthroplasty in cases of knee osteoarthritis associated with major deformities. Material and methods: Present study is based on the surgical treatment, using the constrained knee prosthesis in the primary total knee arthroplasty, during 2019-2021, of 28 patients with knee osteoarthritis associated with severe deformities in varus or valgus, in the Big Joint Replacement Department, Clinical Hospital of Traumatology and Orthopedics, Chisinau. Results: In this study, the following criteria were evaluated: the type of deformity – valgus (10 cases) and varus (18 cases); the degree of deformation – for varus knees was on average 300 , and for valgus knee – 250 ; bone attrition – 11 cases with bone defects where it was necessary to use augmentations; affected side – in 19 cases the right knee was affected and 9 cases the left one; the women/men ratio was 4/1; the mean age of the patients was 67.5 years; average duration of the intervention – 140 minutes; in 5 cases a lateral para-patellar approach was performed, of which 2 cases with tibial tuberosity osteotomy; complications – 1 case with intra-operative periprosthetic fracture and 2 cases with superficial infections of the operated joints. Conclusions: Osteoarthritis of the knee progresses rapidly, leading to severe deformities, significant bone defects and joint instability, which are indications to use the constrained prosthesis in the primary total knee arthroplasty, long-term follow-up is necessary to obtain the last conclusion, but from this study the constrained knee prosthesis like primary implant for special indication had promising results.

Total knee arthroplasty in the valgus knee using a standard medial approach

2008 ◽  
Vol 3 (1) ◽  
pp. 2-5
Author(s):  
J. Bellemans ◽  
H. Vandenneucker ◽  
J. Vanlauwe
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Valgus Knee ◽  
Medial Approach ◽  
Total Knee

scholarly journals Tibial Tubercle Osteotomy in Total Knee Arthroplasty: Midterm Results Experience of a Monocentric Study

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 095-099 ◽  
Author(s):  
Stefano Biggi ◽  
Stefano Divano ◽  
Riccardo Tedino ◽  
Andrea Capuzzo ◽  
Stefano Tornago ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Primary Total Knee Arthroplasty ◽  
Implant Design ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Level Of Evidence ◽  
Total Knee ◽  
Revision Tka

Purpose Difficult primary total knee arthroplasty (TKA) and revision TKA may be high demanding, especially during joint exposure. Aim of this article is to evaluate the clinical and radiological outcomes of a series of patients, who underwent TKA and revision TKA, where tibial tubercle osteotomy (TTO) was performed. Methods We retrospectively reviewed a cohort of 79 consecutives TKAs where TTO was performed. Patients were assessed clinically and radiographically at their last follow-up (mean, 7.4 ± 3.7 years). Clinical evaluation included the Knee Society Score (KSS), the pain visual analogue scale (VAS), and range of motion. Radiological assessment included the evaluation of radiolucent lines, osteolysis, cortical bone hypertrophy, time of bone healing of the TTO fragment, and the hardware complication. Results KSS raised from 40.7 ± 3.1 to 75 ± 4.3 (p < 0.0001). Knee flexion increased from 78.7 ± 9.9° to 95.0 ± 9.5° (p < 0.0001), and VAS improved from 7.9 ± 0.9 to 3.8 ± 1 (p < 0.0001). No signs of loosening or evolutive radiolucency lines were found. Osteolytic areas around the stem were detected. No significant association was found between the implant design and the outcomes, while aseptic loosening showed significantly better results. Complications were: 4 painful hardware, 3 late periprosthetic infections, 1 extension lag of 5°, and 3 flexion lag. Conclusion Our experience suggests the use of TTO to improve the surgical approach in difficult primary TKA or revision TKA. A precise surgical technique leads to good results with low risk of complications. Level of Evidence Level IV, therapeutic case series.

scholarly journals Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

2014 ◽  
Vol 4 (1) ◽  
pp. 8-12
Author(s):  
Andrea Baldini ◽  
Pier Francesco Indelli ◽  
PT Luca Manfredini ◽  
Massimiliano Marcucci
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Primary Total Knee Arthroplasty ◽  
Surface Curvature ◽  
Rotational Alignment ◽  
Tibial Tubercle ◽  
Anterior Tibial ◽  
Total Knee ◽  
Primary Total Knee

ABSTRACT Purpose We hypothesized that the anterior tibial surface curvature is a more reliable landmark for correct tibial component rotational positioning in TKA respect to the ‘Akagi’ line and the medial third of the tibial tubercle. Methods Three independent investigators reviewed 124 knee MRI scans, identifying independently the femoral transepicondylar axis (TEA), the femoral posterior condylar axis (PCA), a line connecting the middle of the posterior cruciate ligament and the medial edge of the patellar tendon attachment (Akagi's line), the medial third of the tibial tubercle and the anterior tibial surface curvature. The most appropriate tibial baseplate tracing for the NexGen Total Knee System (Zimmer, Warsaw, USA) was superimposed matching the anterior tibial cortex with its anterior surface. At this point, the rotation of the tibial plate tracing was calculated in respect to the TEA, the medial third of the tibial tubercle line, the Akagi's line and the PCA. Customized software was created and used for analysis of the MRI datasets. Results: The investigators agreed on the localization of the Akagi's line in 64% of the cases within 3° and in 85% of the cases within 5° (minimum –16°, maximum –7°): this landmark might lead to internal rotation of the tibial component. The observers agreed on the localization of the medial third of the tibial tubercle in 29% of the cases within 3° and, in 70% of the cases, within 5° (minimum –4°, maximum +4°): this landmark might lead to external rotation of the tibial component. The investigators agreed on the localization of the anterior tibial surface curvature in 89% of the cases within 3° and in 99% of the cases within 5° (minimum –1°, maximum +4°): component alignment along the anterior cortex guaranteed full matching ±3° to the epicondylar axis in 75% of the knees. Conclusion Alignment of the tibial component, when based on the anterior tibial surface, was more reliable and easier identifiable than either the Akagi's line or the medial third of the tibial tubercle. Level of evidence Level 3 (Retrospective cohort study). Indelli PF, Baldini A, Manfredini L, Marcucci M. Rotational Alignment Landmarks in Primary Total Knee Arthroplasty. The Duke Orthop J 2014;4(1):8-12.

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