Biochemical stress evaluation after medial parapatellar and subvastus approach in total knee replacement

Abstract

In our experience, the medial subvastus approach, firstly associated with greater surgical stress, has then been characterized by a more favorable functional improvement trend. Moreover, the salivary cortisol measurement has proved to be a non-invasive and reliable method to evaluate the systemic surgery-related stress.

<p>Usefulness of patellar cartilage cross-sectional area for knee tibiofemoral osteoarthritis in elderly</p>

“…Because of their limited healing potential, patellar cartilage defects tend to increase over time and may be considered a major risk factor for KOA 9. KOA characterized by biochemical and structural cartilage abnormalities may ultimately become functionally and symptomatically debilitating 14–16. Painful knee and knee deformity due to KOA result in reduced muscle strength of the thigh 5.…”

Surgical Approaches, Postoperative Care, and Outcomes Associated with Intra-Articular Hoffa Fractures

“…Because of excellent articular visualization and low risk of neurovascular trauma, this method is often preferred 20,21 . Care should be taken to avoid incising transverse fibers of the quadriceps muscles, the infrapatellar branch of the saphenous nerve, and the superior lateral genicular artery 22 . This approach may be utilized in complex fractures of the medial condyle; although studies have shown the subvastus approach to be superior for the medial aspect of the knee in arthroplasty, visualizing the articular surface of the knee may be accomplished with the medial parapatellar approach [23][24][25][26][27] .…”

“…An incision is made at the level of the patella in line with the iliotibial band and curves to include the Gerdy tubercle and end 3 to 4 cm distal to the joint line. The iliotibial band and biceps femoris tendon are anteriorly retracted 22 . If a locking plate is used, this approach allows for more accurate posterolateral implant placement and decreases the risk of neurovascular injury 3 .…”

“…If a locking plate is used, this approach allows for more accurate posterolateral implant placement and decreases the risk of neurovascular injury 3 . Alternatively, the biceps femoris tendon and peroneal nerve can be retracted posteriorly to allow for a posterolateral approach 22 . This may become necessary in the fixation of Letenneur Type-II fractures, which are often not amenable to repair via a lateral or midline approach 4 .…”

“…In a lateral parapatellar approach, a 15 to 18-cm linear skin incision is made over the lateral aspect of the patella extending toward the tibial tubercle 28 . During deeper dissection, care must be taken to preserve the extensor retinaculum and lateral geniculate arteries 22 . Although the common peroneal nerve runs deep to the biceps femoris, it is typically protected from the initial incision.…”