Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study

  • Jean-Michel Laffosse
  • Anna Potapov
  • Michel Malo
  • Martin Lavigne
  • Pascal-André VendittoliEmail author
Clinical Research



The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous hypesthesia and neuroma formation.


We asked whether an anterolateral skin incision to the knee would decrease the area of skin hypesthesia and associated postoperative discomfort.

Patients and Methods

We randomized 69 knees to receive a TKA through either a midline or an anterolateral skin incision. We assessed skin sensitivity by application of the Semmes-Weinstein monofilament at 13 reference points at 6 weeks and 6 and 12 months postoperatively. The area of hypesthesia was measured using Mesurim Pro 9® software. Patient knee ROM, Knee Injury and Osteoarthritis Outcome Score (KOOS), and WOMAC clinical score also were assessed.


The area of hypesthesia was less after an anterolateral compared with a midline incision up to 1 year after surgery: the areas of hypesthesia were, respectively, 32 cm2 versus 76 cm2 at 6 weeks, 14 cm2 versus 29 cm2 at 6 months, and 7 cm2 versus 19 cm2 at 1 year. Clinical scores and knee ROM were similar in both groups at each followup. At 1 year, in the entire group we observed a correlation between a smaller area of paresthesia and better WOMAC and KOOS scores and greater knee flexion.


Compared with the midline skin incision, the anterolateral incision is associated with fewer sensory disturbances and appears to be a reasonable alternative in TKA.

Level of Evidence

Level I, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.


Skin Incision Sensory Disturbance Saphenous Nerve Midline Skin Incision Medial Parapatellar Arthrotomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Daniel Lusignan and Gina Daigneault (research assistants) for help in collecting the data and Michel Fallaha (surgeon).

Supplementary material

Supplementary material 1 (MPEG 41788 kb)

Supplementary material 2 (MPEG 47849 kb)


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Jean-Michel Laffosse
    • 1
  • Anna Potapov
    • 2
  • Michel Malo
    • 3
  • Martin Lavigne
    • 4
  • Pascal-André Vendittoli
    • 4
    Email author
  1. 1.Department of Orthopaedic SurgeryRangueil Hospital CenterToulouseFrance
  2. 2.Department of SurgeryUniversity of MontrealMontrealCanada
  3. 3.Department of Orthopaedic SurgerySacré-Cœur Hospital, University of MontrealMontrealCanada
  4. 4.Department of Orthopaedic SurgeryMaisonneuve-Rosemont Hospital, University of MontrealMontrealCanada

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