Advantages of the Lateral Approach in Severe Genu Valgus Knee Arthroplasty
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Published:
Aug 19, 2021
Keywords:
Valgus, lateral approach, arthroplasty, knee
Main Article Content
Abstract
Introduction: The treatment of severe valgus is complex. The lateral approach described by Keblish is advantageous for the treatment of these deformities. We decided to evaluate our outcomes using a lateral approach in severe genu valgus knee arthroplasty.
Materials and Methods: Of 795 primary arthroplasties from January 2012 to March 2020, we analyzed 40 performed by lateral approach. All had a valgus deformity greater than 20º and a sufficient medial collateral ligament. 33 women (3 bilateral) and 4 men were included. Average age was 71 years (59-79). The main cause was osteoarthrosis (82%). The presurgical deformity was 27º (21-39). The preoperative measurements were: Knee Society Score (KSS) 15 (5 to 42). Preoperative functional score (KFS): 17 (0 to 40). Average surgical time: 91 minutes. The average postoperative follow-up was 37 months.
Results: Postoperative femorotibial angle 6.2º (range 4º to 10º). Postoperative KSS 79 (46-95). KFS 82 (60-100). Complications: 3 cases (7%), one infection, one case with poor positioning of components, and one case of peroneal neuropraxia.
Conclusion: In knee arthroplasty due to genu valgus, this approach allows restoring the femoro-tibial axis and achieving adequate prosthetic stability, even with implants without a greater degree of constraint, with a complication rate comparable to other techniques.
Materials and Methods: Of 795 primary arthroplasties from January 2012 to March 2020, we analyzed 40 performed by lateral approach. All had a valgus deformity greater than 20º and a sufficient medial collateral ligament. 33 women (3 bilateral) and 4 men were included. Average age was 71 years (59-79). The main cause was osteoarthrosis (82%). The presurgical deformity was 27º (21-39). The preoperative measurements were: Knee Society Score (KSS) 15 (5 to 42). Preoperative functional score (KFS): 17 (0 to 40). Average surgical time: 91 minutes. The average postoperative follow-up was 37 months.
Results: Postoperative femorotibial angle 6.2º (range 4º to 10º). Postoperative KSS 79 (46-95). KFS 82 (60-100). Complications: 3 cases (7%), one infection, one case with poor positioning of components, and one case of peroneal neuropraxia.
Conclusion: In knee arthroplasty due to genu valgus, this approach allows restoring the femoro-tibial axis and achieving adequate prosthetic stability, even with implants without a greater degree of constraint, with a complication rate comparable to other techniques.
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How to Cite
Silvano, R. E., Segura, B., Torrecilla, J., Gabrielli, T., González, D., Segura, D., & Soria, R. (2021). Advantages of the Lateral Approach in Severe Genu Valgus Knee Arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 512-518. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1404
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Clinical Research
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References
1. Whiteside L. Soft tissue balancing. The knee. J Arthroplasty 2002;17(4 Suppl 1):23-7. https://doi.org/10.1054/arth.2002.33264
2. Peters CL, Mohr RA, Bachus KN. Primary total knee arthroplasty in the valgus knee. Creating a balanced soft tissue envelope. J Arthroplasty 2001;16(6):721-9. https://doi.org/10.1054/arth.2001.25504
3. MacAuley JP, Engh GA. Constraint in total knee arthroplasty. When and what? J Arthroplasty 2003;18(3 Suppl
1):51-4. https://doi.org/10.1054/arth.2003.50103
4. Williot A, Rosset P, Favard L, BrilHault J, Burdin P. Total knee arthroplasty in valgus knee. Orthop Traumatol Surg Res 2010;96(4 Suppl):S37-S42. https://doi.org/10.1016/j.otsr.2010.03.009
5. Scuderi GR, Sikorskii A, Bourne RB, Lonner JH, Benjamin JB, Noble PC. The Knee Society. Short form reduces
respondent burden in the assessment of patient-reported outcomes. Clin Orthop Relat Res 2016;474(1):134-42.
https://doi.org/10.1007/s11999-015-4370-2
6. Pons i Cabrafiga M, Alvarez Goenaga F, Solana i Carné J, Vidalot i Pericé R. Abordaje lateral en artroplastia total
de rodilla con genu valgo marcado. Rev Esp Cir Ortop Traumatol 2003;47(2):113-9. https://doi.org/10.1016/S1888-4415(03)76081-0
7. Betancout Perez RE. Abordaje lateral para reemplazo total de rodillas en valgos severos estructurados. Descripción de una nueva técnica y reporte preliminar de casos. Rev Colomb Ortop Traumatol 2008;22(3):178-84. Disponible en: http://www.sccot.org.co/pdf/RevistaDigital/22-03-2008/05Abordaje.pdf
8. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res 1991;(271):52-62. PMID: 1914314
9. Greenberg A, Kandel L, Liebergall M, Mattan Y, Rivkin G. Total knee arthroplasty for valgus deformity via a
lateral approach: Clinical results, comparison to medial approach, and review of recent literature. J Arthroplasty
2020;35(8):2076-83. https://doi.org/10.1016/j.arth.2020.03.037
10. Wang B, Xing D, Li JJ, Zhu Y, Dong S, Zhao B. Lateral or medial approach for valgus knee in total knee
arthroplasty - which one is better? A systematic review. J Int Med Rev 2019 47(11):5400-13.
https://doi.org/10.1177/0300060519882208
11. Ranawat AS, Ranawat C, Elkus M, Rasquinha V, Rossi R, Babhulkar S. Total knee arthroplasty for severe valgus
deformity. J Bone J Surg Am 2005;87(Suppl 1 Pt 2):271-84. https://doi.org/10.2106/JBJS.E.00308
12. Weber A, Jessup DE, Keenan J, Worland R. The consequences of lateral release in total knee replacement: a review of over 1000 knees with follow up between 5 and 11 years. Knee 2003;10(2):187-91. https://doi.org/10.1016/s0968-0160(02)00059-5
13. Konopka J, Weitzler L, Westrich D, Wright TM, Geoffrey H, Westrich GH. The effect of constraint on post
damage in total knee arthroplasty: posterior stabilized vs posterior stabilized constraint inserts. Arthroplasty Today 2017;4(2):200-4. https://doi.org/10.1016/j.artd.2017.11.001
14. Badway M, Fenstad AM, Furnes O. Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report from the Norwegian Arthroplasty register 1994-2017. Acta Orthop 2019;90(5):467-72. https://doi.org/10.1080/17453674.2019.1627638
2. Peters CL, Mohr RA, Bachus KN. Primary total knee arthroplasty in the valgus knee. Creating a balanced soft tissue envelope. J Arthroplasty 2001;16(6):721-9. https://doi.org/10.1054/arth.2001.25504
3. MacAuley JP, Engh GA. Constraint in total knee arthroplasty. When and what? J Arthroplasty 2003;18(3 Suppl
1):51-4. https://doi.org/10.1054/arth.2003.50103
4. Williot A, Rosset P, Favard L, BrilHault J, Burdin P. Total knee arthroplasty in valgus knee. Orthop Traumatol Surg Res 2010;96(4 Suppl):S37-S42. https://doi.org/10.1016/j.otsr.2010.03.009
5. Scuderi GR, Sikorskii A, Bourne RB, Lonner JH, Benjamin JB, Noble PC. The Knee Society. Short form reduces
respondent burden in the assessment of patient-reported outcomes. Clin Orthop Relat Res 2016;474(1):134-42.
https://doi.org/10.1007/s11999-015-4370-2
6. Pons i Cabrafiga M, Alvarez Goenaga F, Solana i Carné J, Vidalot i Pericé R. Abordaje lateral en artroplastia total
de rodilla con genu valgo marcado. Rev Esp Cir Ortop Traumatol 2003;47(2):113-9. https://doi.org/10.1016/S1888-4415(03)76081-0
7. Betancout Perez RE. Abordaje lateral para reemplazo total de rodillas en valgos severos estructurados. Descripción de una nueva técnica y reporte preliminar de casos. Rev Colomb Ortop Traumatol 2008;22(3):178-84. Disponible en: http://www.sccot.org.co/pdf/RevistaDigital/22-03-2008/05Abordaje.pdf
8. Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res 1991;(271):52-62. PMID: 1914314
9. Greenberg A, Kandel L, Liebergall M, Mattan Y, Rivkin G. Total knee arthroplasty for valgus deformity via a
lateral approach: Clinical results, comparison to medial approach, and review of recent literature. J Arthroplasty
2020;35(8):2076-83. https://doi.org/10.1016/j.arth.2020.03.037
10. Wang B, Xing D, Li JJ, Zhu Y, Dong S, Zhao B. Lateral or medial approach for valgus knee in total knee
arthroplasty - which one is better? A systematic review. J Int Med Rev 2019 47(11):5400-13.
https://doi.org/10.1177/0300060519882208
11. Ranawat AS, Ranawat C, Elkus M, Rasquinha V, Rossi R, Babhulkar S. Total knee arthroplasty for severe valgus
deformity. J Bone J Surg Am 2005;87(Suppl 1 Pt 2):271-84. https://doi.org/10.2106/JBJS.E.00308
12. Weber A, Jessup DE, Keenan J, Worland R. The consequences of lateral release in total knee replacement: a review of over 1000 knees with follow up between 5 and 11 years. Knee 2003;10(2):187-91. https://doi.org/10.1016/s0968-0160(02)00059-5
13. Konopka J, Weitzler L, Westrich D, Wright TM, Geoffrey H, Westrich GH. The effect of constraint on post
damage in total knee arthroplasty: posterior stabilized vs posterior stabilized constraint inserts. Arthroplasty Today 2017;4(2):200-4. https://doi.org/10.1016/j.artd.2017.11.001
14. Badway M, Fenstad AM, Furnes O. Primary constrained and hinged total knee arthroplasty: 2- and 5-year revision risk compared with unconstrained total knee arthroplasty: a report from the Norwegian Arthroplasty register 1994-2017. Acta Orthop 2019;90(5):467-72. https://doi.org/10.1080/17453674.2019.1627638