Abstract:Objective To explore the clinical effect of lateral approach combined with lateral femoral sliding osteotomy in valgus knee.Methods Retrospectively reviewed 22 patients diagnosed as valgus knee were treated with total knee arthroplasty by lateral approach combined with lateral femoral sliding osteotomy at Luoyang Orthopedic-Traumatological Hospital from February 2016 to April 2018.There were 6 males and 16 females.The patients aged from 58 to 78 years,with an average age of(67.5±7.9) years.The surgical time,perioperative blood loss,length of hospital stay,complications were recorded,and the radiographic anteroposterior view of the knee and clinical outcomes at last follow-up were compared with that before surgery.Results All patients were inserted with posterior stabilized(PS) prosthesis.No constrained and hinged prosthesis were used.The surgical time was(90.2±12.3) min,and the intraoperative blood loss was(150.0 ±34.7) ml.The followed up time was 24 to 63 months(mean,40.2±10.7 months).Preoperative knee society score(KSS),Western Ontario McMaster Universities(WOMAC),and range of motion(ROM) were(45.5±10.3),(77.1±9.7),(77.3±6.3) °,respectively.Preoperative hip knee ankle angle(HKA) and mechanical lateral distal femoral angle(mLDFA) were(193.6±7.5) °,(97.0±3.1) °,respectively.The KSS,WOMAC,ROM at last follow-up were(90.3±10.6),(37.6±7.5),(110.0±6.3) °,respectively,which were significantly better than those of pre-operation(P<0.05).The postoperative HKA and mLDFA were(181.4±2.6) °,(87.5±2.9) ° respectively,which were significantly improved than those of pre-operation(P<0.05).Conclusion Lateral approach combined with lateral femoral sliding osteotomy is effective in the treated with valgus knee,without the needed of high grade of constraint of the implant during TKA.
[1]NicoletPetersen S,Saiz A,Shelton T,et al.Kinematically aligned TKA restores physiological patellofemoral biomechanics in the sagittal plane during a deep knee bend[J].Knee Surg Sports Traumatol Arthrosc,2020,28(5):1497-1507.
[2]Brilhault J,Lautman S,Favard L,et al.Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity[J].J Bone Joint Surg(Br),2002,84(8):1131-1137.
[3]Zhou X,Wang M,Liu C,et al.Total knee arthroplasty for severe valgus deformity[J].J Bone Joint Surg(Am),2005,87 Suppl 1(Pt 2):271-284.
[4]Erard J,Batailler C,Swan J,et al.Lateral approach total knee arthroplasty achieves equivalent patellar tracking in severe valgus deformity compared to mild valgus deformity[J].Knee Surg Sports Traumatol Arthrosc,2022,30(2):740-752.
[5]Theil C,Schwarze J,Gosheger G,et al.Good to excellent long-term survival of a single-design condylar constrained knee arthroplasty for primary and revision surgery[J].Knee Surg Sports Traumatol Arthrosc,2022,30(9):3184-3190.
[6]Xie K,Lyons ST.Soft tissue releases in total knee arthroplasty for valgus deformities[J].J Arthroplasty,2017,32(6):1814-1188.
[7]Figueroa F,Figueroa D,Putnis S,et al.Posterolateral corner knee injuries:a narrative review[J].EFORT Open Rev,2021,6(8):676-685.
[8]Verhamme P,Yi BA,Segers A,et al.Abelacimab for prevention of venous thromboembolism[J].N Engl J Med,2021,385(7):609-617.
[9]Erard J,Batailler C,Swan J,et al.Lateral approach total knee arthroplasty achieves equivalent patellar tracking in severe valgus deformity compared to mild valgus deformity[J].Knee Surg Sports Traumatol Arthrosc,2022,30(2):740-752.
[10]Dalal SS,Chandratreya A,Singhal K,et al.Incidence of soft-tissue releases,clinical and radiological outcomes of lateral parapatellar approach for valgus arthritic knees:A 4year follow-up study with a review of literature[J].Indian J Orthop,2021,55(Suppl 1):38-45.
[11]Keblish PA.The lateral approach to the valgus knee.Surgical technique and analysis of 53 cases with over two-year follow-up evaluation[J].Clin Orthop Relat Res,1991(271):52-62.
[12]Dudek P,Marczak D,Okoń T,et al.Lateral or medial parapatellar surgical approach to the valgus osteoarthritic knee? A retrospective single-center study[J].J Clin Med,2022,11(19):5953-5064.
[13]Bar-Ziv Y,Beit Ner E,Lamykin K,et al.Minimum 2-year radiographic and clinical outcomes of kinematic alignment total knee arthroplasty in the valgus knee[J].J Pers Med,2022,12(7):1164-1173.
[14]Sidhu SP,Somerville LE,Sidhu AS,et al.Does surgical approach affect patient outcomes of total knee arthroplasty?[J].Can J Surg,2021,64(5):E521-e526.
[15]DeBell H,Pinter Z,Pinto M,et al.Vascular supply at risk during lateral release of the patella during total knee arthroplasty:A cadaveric study[J].J Clin Orthop Trauma,2019,10(1):107-110.