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Lateral approach to the knee combined with an osteotomy of the tibial tuberosity its use for total knee replacement

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Orthopaedics and Traumatology

Summary

Objectives

Simple standard approach to the knee for implantation of a total knee prosthesis.

Indications

Insertion of a total knee prosthesis.

Contraindications

Existing scars from medial or lateral approaches to the knee. The distance between old scar and planned incision should never be less than 5 cm.

Surgical Technique

Lateral parapatellar approach with judicious detachment of the iliotibial tract from Gerdy’s tubercle. Opening of the compartment of tibialis anterior muscle. Mobilization of the patellar ligament together with Hoffa’s fat pad in a medial direction. Osteotomy of the tibial tuberosity. Retraction of the distal part of the quadriceps, the patella, the patellar ligament and the tibial tuberosity medially, taking care not to detach the soft tissue from the medial side of the tuberosity. After insertion of the components refixation of the tibial tuberosity with two 3.5-mm cortical screws using the lag screw principle.

Postoperative Care

Unrestricted functional treatment possible starting day 1.

Results

Since 1990 we implanted 702 total knee prostheses using the described approach. In 99% of the patients the osteotomy consolidated during the first 3 months without formation of a callus. Complications attributable to the osteotomy of the tuberosity were encountered in 7 patients (1%).

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References

  1. Aglietti P, Buzzi R, D’Andria S, et al. Quadricepsplasty with the V-Y incision in total knee arthroplasty. Ital J Orthop Traumatol 1991;17:23–9.

    CAS  PubMed  Google Scholar 

  2. Arnold MP, Friederich NF, Widmer H, et al. Patellaersatz bei Knietotalendoprothesen — notwendig? Orthopäde 1998;27:637–41.

    CAS  PubMed  Google Scholar 

  3. Berger RA, Rubash HE, Seel MJ, et al. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop 1993;286:40–7.

    PubMed  Google Scholar 

  4. Buechel FF. A sequential three-step lateral release for correcting fixed valgus knee deformities during total knee arthroplasty. Clin Orthop 1990;260:170–5.

    PubMed  Google Scholar 

  5. Engh GA, Holt BT, Parks NL. A midvastus musclesplitting approach for total knee arthroplasty. J Arthroplasty 1997;12:322–31.

    Article  CAS  PubMed  Google Scholar 

  6. Faure BT, Benjamin JB, Lindsey B, et al. Comparison of the subvastus and paramedian surgical approaches in bilateral knee arthroplasty. J Arthroplasty 1993;8:511–6.

    Article  CAS  PubMed  Google Scholar 

  7. Fernandez DL. Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures. J Bone Joint Surg [Am] 1988;70:208–19.

    CAS  Google Scholar 

  8. Fulkerson JP. Disorders of the patellofemoral joint, 3rd edn. Baltimore: Williams & Wilkins, 1997.

    Google Scholar 

  9. Hofmann AA, Plaster RL, Murdock LE. Subvastus (Southern) approach for primary total knee arthroplasty. Clin Orthop 1991;269:70–7.

    PubMed  Google Scholar 

  10. Masini MA, Stulberg DS. A new surgical technique for tibial tubercle transfer in total knee arthroplasty. J Arthroplasty 1992;7:81–6.

    Article  CAS  PubMed  Google Scholar 

  11. Mertl P, Jarde O, Blejwas D, et al. L’abord lateral du genou avec relèvement de la tubérosité tibiale pour la chirurgie prothétique. Rev Chir Orthop 1992;78:264–8.

    CAS  PubMed  Google Scholar 

  12. Müller W. Das Knie, Form, Funktion und ligamentäre Wiederherstellungschirurgie. Berlin: Springer, 1982.

    Google Scholar 

  13. Van Kampen A. The three-dimensional tracking pattern of the patella-in vitro analysis. Nijmegen, NL: Thesis, University of Nijmegen, 1987.

  14. Vince KG, Dorr LD. Surgical technique of total knee arthroplasty: principles and controversy. Tech Orthop 1987;17:69–80.

    Google Scholar 

  15. Whiteside LA, Ohl MD. Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop 1990;260:6–9.

    PubMed  Google Scholar 

  16. Wolff MA, Hungerford DS, Krackow KA, et al. Osteotomy of the tibial tubercle during total knee replacement. J Bone Joint Surg [Am] 1989;71:847–52.

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital, Bruderholz, CH-4101, Bruderholz, Switzerland

    Markus Paul Arnold, Niklaus Felix Friederich, Heinz Widmer & Werner Müller

Authors
  1. Markus Paul Arnold
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  2. Niklaus Felix Friederich
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  3. Heinz Widmer
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  4. Werner Müller
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Corresponding author

Correspondence to Markus Paul Arnold.

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Arnold, M.P., Friederich, N.F., Widmer, H. et al. Lateral approach to the knee combined with an osteotomy of the tibial tuberosity its use for total knee replacement. Orthop Traumatol 7, 212–220 (1999). https://doi.org/10.1007/BF03180940

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  • DOI: https://doi.org/10.1007/BF03180940

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