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Medial Versus Lateral Parapatellar Approach for Total Knee Arthroplasty…
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tibial tubercle osteotomy, anticipated difficulty
in lateral soft tissue closure, and increased
surgical time. We noted a greater number of
TTO in the lateral approach group, but these
were performed more often in the beginning of
our study. As time passed, the TTO rate
decreased, and was never performed in the last
5 years of our experience (164 patients). We
did not find any difference of surgical and
tourniquet time between medial and lateral
approach. These results confirm that the
systematic use of the lateral approach for
valgus knee is safe and efficient. Further, no
difference in complication risk was noted
between the two groups, in spite of the more
frequent performance of a TTO in the lateral
approach group.
Medial and lateral parapatellar approaches
resulted in similar, good results following TKA
in knees with mild valgus. The lateral
parapatellar approach is a safe, effective
surgical technique for the performance of TKA
in the setting of moderate knee valgus. Surgical
time, complications, and short-term results are
equivalent to the medial parapatellar approach.
Table 2 - Intra-operative
Lateral Approach
n = 315
Medial Approach
n = 109
Significance
Surgical Time (minutes)
90.5 ± 23.8
89.3 ± 21.1
p = 0.62
Tourniquet Time (minutes)
78.4 ± 20.4
76.1 ± 17.1
p = 0.25
Lateral Release needed :
. None or Capsule only
. Popliteus
. IT Band
. Osteotomy of LFC
. Other
204 (64.6%)
12 (3.8%)
86 (27.3%)
1 (0.3%)
12 (4.1%)
86 (79.6%)
13 (12.0%)
3 (2.8%)
1 (0.9%)
6 (5.5%)
p = 0.006
p = 0.004
p < 0.0001
p = 1.0
p = 0.42
Tibial tuberosity osteotomy
65 (28%)
9 (8%)
p = 0.003
Table 3 - Results
Lateral Approach
n = 238
Medial Approach
n = 89
Significance
Follow-up (years)
2.8 ± 3.4
5.1 ± 4.2
p < 0.0001
IKS Knee Score
88.8 ± 13.7
86.9 ± 15.7
p = 0.32
IKS Function Score
74.3 ± 24.6
72.1 ± 24.8
p = 0.47
Flexion contracture of 5 deg or
greater
9 (3.8%)
8 (9.0%)
p = 0.09
Alignment :
. HKAA (degrees)
. FMA (degrees)
.
TMA (degrees)
180.7 ± 2.9
90.3 ± 1.8
90.4 ± 1.9
180.8 ± 2.8
90.5 ± 2.0
90.1 ± 1.2
p = 0.78
p = 0.41
p = 0.09
Blackburne-Peel Index
0.64 ± 0.22
0.62 ± 0.21
p = 0.45
Complications :
. Fracture
. Skin necrosis
. Infection
5 (1.5%)
2 (0.6%)
3 (0.9%)
3 (2.8%)
1 (0.9%)
3 (2.8%)
p = 0.53