Abstract
The purpose of this work was to document eleven years of experience in knee replacement for fixed knee valgus through a lateral approach with special emphasis on the balancing procedures. At a mean follow-up of seven years, only one revision for sepsis was required in this series of 63 knee replacements. The mean knee score improved from 37 (range 20–45) to 91 (range 65–100) at the last review (p < 0.01) while the function score increased from 29.5 (range 0–50) to 78.7 (range 10–100) (p = 0.01). The mean mechanical axis (HKA) was 14.7° of valgus preoperatively and 1° of valgus postoperatively. After the iliotibial band was automatically released in the approach, only four of 63 knees required additional release for tightness in extension. These results underline the appeal of the lateral approach with the automatic release of the iliotibial band. If required, additional ligament release is recommended step-by-step after bone section to avoid postoperative instability.
Résumé
Le but de cette étude était de rapporter onze années d’expérience de la voie d’abord latérale du genou pour implantation d’une prothèse totale pour genu valgum fixé. Une attention particulière a été portée sur les techniques d’équilibrage ligamentaire. Au recul moyen de 7 ans, une seule reprise chirurgicale dans notre série de 63 prothèses avait été nécessaire en raison d’une infection. Le score moyen du genou était de 37 (20 à 45) en post-opératoire et de 91 (65 à 100) au dernier recul (p < 0.01) alors que le score fonctionnel passait de 29.5 (0 à50) à 78.7 (10 à 100) (p = 0.01). L’axe mécanique HKA était de 14.7° de valgus en préopératoire et de 1° de valgus en post-opératoire. Après libération de la bandelette ilio-tibiale, seulement 4 sur 63 des genoux nécessitaient des gestes de libérations supplémentaires pour raideur en extension.
Similar content being viewed by others
References
Brilhault J, Lautman S, Favard L, Burdin P (2002) Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. J Bone Joint Surg Br 84:1131–1137
Buechel F (1990) A sequential three-step lateral release for correcting fixed valgus knee deformities during total knee arthroplasty. Clin Orthop Relat Res 170–175
Burki H, Von Knoch M, Heiss C, Drobny T, Munzinger U (1999) Lateral approach with osteotomy of the tibial tubercle in primary total knee arthroplasty. Clin Orthop Relat Res 362:156–161
Clarke HD, Fuchs R, Scuderi GR, Scott WN, Insall JN (2005) Clinical results in valgus total knee arthroplasty with the “pie crust” technique of lateral soft tissue releases. J Arthroplasty 20:1010–1014
Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12
Fiddian NJ, Blakeway C, Kumar A (1998) Replacement arthroplasty of the valgus knee. A modified lateral capsular approach with repositioning of vastus lateralis. J Bone Joint Surg Br 80:859–861
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 13–14
Ito J, Koshino T, Okamoto R, Saito T (2003) 15-year follow-up study of total knee arthroplasty in patients with rheumatoid arthritis. J Arthroplasty 18:984–992
Kayler DE, Lyttle D (1988) Surgical interruption of patellar blood supply by total knee arthroplasty. Clin Orthop Relat Res 221–227
Keblish PA (1991) The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res 52–62
Krackow KA, Jones MM, Teeny SM, Hungerford DS (1991) Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res 9–18
Lootvoet L, Blouard E, Himmer O, Ghosez JP (1997) Complete knee prosthesis in severe genu valgum. Retrospective review of 90 knees surgically treated through the anterio-external approach. Acta Orthop Belg 63:278–286
Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME (2004) Long-term followup of posterior-cruciate-retaining TKR in patients with rheumatoid arthritis. Clin Orthop Relat Res 146–152
Mertl P, Jarde O, Blejwas D, Vives P (1992) Lateral approach of the knee with tibial tubercle osteotomy for prosthetic surgery. Rev Chir Orthop Reparatrice Appar Mot 78:264–267
Miyasaka KC, Ranawat CS, Mullaji A (1997) 10- to 20-year follow-up of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 29–37
Nicholls RL, Green D, Kuster MS (2006) Patella intraosseous blood flow disturbance during a medial or lateral arthrotomy in total knee arthroplasty: a laser Doppler flowmetry study. Knee Surg Sports Traumatol Arthrosc 14:411–416
Ranawat AS, Ranawat CS, Elkus M, Rasquinha VJ, Rossi R, Babhulkar S (2005) Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg Am 87(Suppl 1):271–184
Stehlik J, Musil D, Held M, Starek M (2006) Z-plasty for valgus deformity in total knee arthroplasty. Acta Chir Orthop Traumatol Cech 73:169–175
Stern SH, Moeckel BH, Insall JN (1991) Total knee arthroplasty in valgus knees. Clin Orthop Relat Res 5–8
Whiteside LA (1999) Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res 130–140
Wolff AM, Hungerford DS, Krackow KA, Jacobs MA (1989) Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg Am 71:848–852
Author information
Authors and Affiliations
Consortia
Corresponding author
Rights and permissions
About this article
Cite this article
Boyer, P., Boublil, D., Magrino, B. et al. Total knee replacement in the fixed valgus deformity using a lateral approach: role of the automatic iliotibial band release for a successful balancing. International Orthopaedics (SICOT) 33, 1577–1583 (2009). https://doi.org/10.1007/s00264-008-0698-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-008-0698-5