Hadassah-Hebrew University Medical Center, Department of Orthopaedic Surgery, Jerusalem, Israel; Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY.
Hadassah-Hebrew University Medical Center, Department of Orthopaedic Surgery, Jerusalem, Israel.
J Arthroplasty. 2020 Aug;35(8):2076-2083. doi: 10.1016/j.arth.2020.03.037. Epub 2020 Mar 30.
Total knee arthroplasty (TKA) for valgus deformity is a challenge. The standard medial parapatellar approach may not be universally useful for this. We have adopted the lateral approach to valgus knees. Here we describe our experience with this approach, present early results, and compare them to the medial approach.
Our institutional registry was queried for all patients with valgus deformity who underwent a TKA via a lateral approach between 2013 and 2016. The registry was also queried for patients with valgus deformity who underwent a TKA through a medial approach in previous years and this data was compared to the study group.
Seventy-nine valgus knees in 72 patients were operated through a lateral approach. Deformity was corrected by 10.8°, from 16.2° to 5.4° (P < .001). Patellar tilt improved from -2.3° to 0.3° (P = .037). Seven implants (9%) were constrained. Mean operating time was 87 minutes (range 53-137). Twenty-five knees in 23 patients were operated via the medial approach. Deformity was corrected by 7.3°, from 13.2° to 5.9° (P < .001). Mean operating time was 137 minutes (range 90-230). Constrained implants were used in 16% of cases. The lateral approach allowed better correction of valgus deformity (10.8 vs 7.3, P = .03) and shorter operative times (87 vs 137 minutes, P < .001).
A lateral approach TKA for valgus deformity improves knee alignment and patellar tilt. Compared to the medial approach, it allows better correction of the deformity, shorter operating times, and perhaps less use of constrained implants.
外翻畸形的全膝关节置换术（TKA）是一个挑战。标准的内侧髌旁入路可能对此并不通用。我们已经采用了外侧入路来治疗外翻膝。在此，我们描述了我们使用这种方法的经验，介绍了早期结果，并将其与内侧入路进行了比较。
我们查询了 2013 年至 2016 年间通过外侧入路接受 TKA 的所有外翻畸形患者的机构登记处。还查询了前几年通过内侧入路接受 TKA 的外翻畸形患者的登记处，并将这些数据与研究组进行了比较。
72 名患者的 79 个外翻膝通过外侧入路进行了手术。畸形从 16.2°矫正至 5.4°，矫正了 10.8°（P<.001）。髌骨倾斜从-2.3°改善至 0.3°（P=0.037）。7 个（9%）植入物为约束型。平均手术时间为 87 分钟（53-137 分钟）。23 名患者的 25 个膝关节通过内侧入路进行了手术。畸形从 13.2°矫正至 5.9°，矫正了 7.3°（P<.001）。平均手术时间为 137 分钟（90-230 分钟）。约束型植入物的使用率为 16%。外侧入路可更好地矫正外翻畸形（10.8 与 7.3，P=0.03），且手术时间更短（87 与 137 分钟，P<.001）。
外侧入路 TKA 治疗外翻畸形可改善膝关节对线和髌骨倾斜。与内侧入路相比，它可以更好地矫正畸形，缩短手术时间，并且可能减少约束型植入物的使用。
