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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

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.

Questions/purposes

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.

Results

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.

Conclusions

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.

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Acknowledgments

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

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rangueil Hospital Center, Toulouse, France

    Jean-Michel Laffosse MD

  2. Department of Surgery, University of Montreal, Montreal, QC, Canada

    Anna Potapov MD

  3. Department of Orthopaedic Surgery, Sacré-Cœur Hospital, University of Montreal, Montreal, QC, Canada

    Michel Malo MD

  4. Department of Orthopaedic Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, 5415 L’Assomption Boulevard, Montreal, QC, H1T 2M4, Canada

    Martin Lavigne MD & Pascal-André Vendittoli MD

Authors
  1. Jean-Michel Laffosse MD
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  2. Anna Potapov MD
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  3. Michel Malo MD
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  4. Martin Lavigne MD
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  5. Pascal-André Vendittoli MD
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Corresponding author

Correspondence to Pascal-André Vendittoli MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

The institution of the authors (PAV, ML) has received funding from Zimmer, Warsaw, IN, USA, to complete this research project.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Montreal.

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Laffosse, JM., Potapov, A., Malo, M. et al. Hypesthesia after Anterolateral versus Midline Skin Incision in TKA: A Randomized Study. Clin Orthop Relat Res 469, 3154–3163 (2011). https://doi.org/10.1007/s11999-011-1973-0

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  • DOI: https://doi.org/10.1007/s11999-011-1973-0

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