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Lateral approach total knee arthroplasty achieves equivalent patellar tracking in severe valgus deformity compared to mild valgus deformity

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patellar tracking problems represent 2–10% of complications of total knee arthroplasties (TKA) in valgus knees. However, there are no studies assessing patellar tracking according to the severity of the valgus deformity. The hypothesis was that lateral approach TKA in severe valgus deformity provides equivalent patellar tracking to that in knees with mild valgus deformity.

Methods

Between 1988 and 2016, 77 TKAs were performed via a lateral approach on a severe valgus deformity (HKA > 195°). Forty-three TKAs performed without tibial tubercle osteotomy and with complete radiological data were included in this study. These were compared with 86 matched TKAs performed via a lateral approach with a mild valgus deformity (HKA between 181° and 190°). Patellar tilt and patellar position were assessed by axial view radiographs at the last follow-up. Complications and clinical outcomes were also evaluated.

Results

The follow-up was mean 52 ± 21 months in the severe valgus group. No significant differences were found between the severe valgus deformity group and the mild valgus deformity groups in patellar tilt (1.6° ± 6.6° versus 1.9° ± 3.2°, respectively) or patellar subluxation. There were complications in 12% (n = 5) and 11% (n = 9) of the severe valgus group and the mild valgus group respectively, without significant difference. There was no significant difference in extensor mechanism complication rate (2.3% versus 4.7%, respectively).

Conclusion

Lateral parapatellar approach, without tibial tubercle osteotomy, for TKA in severe valgus deformity results in good patellar tracking. With this approach, the extensor mechanism complication rate in severe valgus deformity was not higher than for mild valgus deformity.

Level of evidence

III.

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Abbreviations

BMI:

Body mass index

FMA:

Femoral mechanical angle

HKA:

Hip knee ankle

KSS:

Knee Society Score

OA:

Osteoarthritis

ROM:

Range of motion

TKA:

Total knee arthroplasty

TMA:

Tibial mechanical angle

TTO:

Tibial tubercle osteotomy

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France

    Julien Erard, Cécile Batailler, John Swan, Elliot Sappey-Marinier, Elvire Servien & Sébastien Lustig

  2. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France

    Cécile Batailler & Sébastien Lustig

  3. LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

Authors
  1. Julien Erard
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  2. Cécile Batailler
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  3. John Swan
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  4. Elliot Sappey-Marinier
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  5. Elvire Servien
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  6. Sébastien Lustig
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Contributions

JE: study design, data collection, literature review and manuscript writing. CB: study design, statistical analysis, literature review and manuscript editing. JS, ESM, ES: study design, literature review and manuscript editing. SL: study design, supervision, literature review and manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cécile Batailler.

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Conflict of interest

JE, CB, JS and ESM declare that they have no conflict of interest. ES: Consultant for Corin. SL: Consultant for Stryker, Smith Nephew, Heraeus, Depuy Synthes; Institutional research support from Groupe Lepine, Amplitude; Editorial Board for Journal of Bone and Joint Surgery (Am).

Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards. As per institutional standards, formal patient consent is not required for this type of study. The French advisory committee on health research data processing (Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Santé, CCTIRS) approved this study on January 24th 2012 and again on March 9th 2015 (approval #11-681).

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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. Knee Surg Sports Traumatol Arthrosc 30, 740–752 (2022). https://doi.org/10.1007/s00167-021-06451-9

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