Lateral or medial approach for valgus knee in total knee arthroplasty - which one is better? A systematic review

Abstract

ObjectiveTo identify whether the medial or lateral approach is superior for patients with valgus knees undergoing primary total knee arthroplasty (TKA).MethodsStudies evaluating the 2 approaches were sourced from the PUBMED, EMBASE, Web of Science, and OVID databases. The quality of included studies was assessed using a modified quality evaluation method, and differences between approaches were systematically reviewed.ResultsSeventeen observational studies were included. The studies were published between 1991 and 2016, and included 5 retrospective studies and 12 prospective studies. Sixteen evaluation methods for the study outcomes were identified. Twelve and eight complication types were identified by studies reporting the lateral and medial approaches for valgus knee, respectively. Several studies showed that pain scores and knee function were superior using a lateral approach.ConclusionThe lateral approach (combined with a tibial tubercle osteotomy or proximal quadriceps snip) was more useful and safer than the medial approach in the treatment of severe uncorrectable valgus knee deformity in patients undergoing TKA. Most of the available evidence supports the use of a lateral approach provided that the surgeon is familiar with the pathological anatomy of the valgus knee.

Ventajas del abordaje externo para la artroplastia de rodilla por genu valgo severo

“…La mejoría de los puntajes funcionales medidos fue notable y fueron comparables con los de otras técnicas quirúrgicas. 10 Es importante remarcar que, de ser necesario, este abordaje permite realizar gestos quirúrgicos adicionales para mejorar el balance ligamentario y la estabilidad de la prótesis, por ejemplo, una osteotomía del epicóndilo externo. En nuestra serie, fue necesario en cinco casos.…”

Lateral Knee Osteoarthritis

“…The main indication for total knee arthroplasty is tricompartmental joint disease associated with limited response to pain despite nonoperative treatment and other surgical treatment modalities. [41,42] Krackow KA classification cited by Greenberg A et al is useful during the performance of total knee arthroplasty in patients with valgus deformity and is divided into three grades (Table 3).…”

“…Valgus contracture causes contracture of the lateral structures, hence the need for extensive releases to achieve alignment and balance of the ligaments, and for this reason patellofemoral instability and peroneal nerve injuries can occur. [42,43] At present, robotic and navigational surgery significantly improve the short-term and long-term results of all the surgical modalities described above.…”

Valgus deformiteli dizde total diz protezi

“…[6] Medial destek yapılarının serbestleştirilmesinin genellikle öngörülebilir şekilde gerçekleştirilebildiği bir varus deformiteli dizden farklı olarak, valgus dizde lateral yapıların gevşetilme sırası halen tartışmalı ve sonuçları daha az tahmin edilebilirdir. [5,7] Lateral yapıların yetersiz gevşetilmesi rezidüel (kalıcı) deformiteye yol açabilirken; aşırı gevşetilmesi ise ameliyat sonrası mediolateral instabiliteye ve dolayısıyla kısıtlı implantların zorunlu kullanımına neden olabilir. [3,5] Kısıtlı implantların kullanımının, kısa ve orta vadeli takiplerde çok iyi sonuçlara sahip olmasına rağmen, kemik-implant ara yüzünde artan stres nedeniyle protez gevşemesi olasılığı dâhil olmak üzere uzun dönem sonuçları yüz güldürücü değildir.…”

“…[10] Lateral yumuşak dokuların kontraktürü, iç yan bağın (İYB) gevşekliği ile ilişkili olabilir ve ileri deformiteli olgularda bu karmaşık tabloya İYB yetmezliği de eklenebilir. [4,7]…”