Skip to main content
SpringerLink
Log in

Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

To analyse the incidence of additional soft tissue releases with the lateral parapatellar approach, and the clinical and radiological outcomes of total knee arthroplasties performed using the lateral parapatellar approach for valgus arthritic knees. A review of the existing literature on valgus arthritic knees undergoing knee replacement was performed and our results compared.

Materials and Methods

This is a prospective cohort study of 50 patients operated by this approach. Operation and clinical records were assessed to determine the number and sequence of soft tissue releases. Functional outcome was measured using the Oxford Knee Score. Radiological assessment included measurement of alignment and implant positioning.

Results

46 patients included. Mean follow-up of 4 years. Additional lateral releases were performed in 11 (24%) cases. Mean valgus alignment corrected from 13.1 degrees pre-operatively to 5.7 degrees post-operatively. Oxford Knee Score improved from a mean pre-operative score of 11.9 to a mean post-operative score of 38.3 at final follow-up. Radiographs revealed lateralisation of the tibial component in 4 patients. No immediate or late post-operative wound complications, late instabilities or revisions were observed.

Conclusion

Lateral parapatellar approach is highly effective in correcting the valgus deformity with a low incidence of additional soft tissue releases. Medium-term results indicate an excellent functional outcome with no complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

TKA:

Total Knee Arthroplasty

ITB:

Iliotibial band

LCL:

Lateral collateral ligament

PLC:

Posterolateral capsule

PCL:

Posterior cruciate ligament

POP:

Popliteus tendon

ERAS:

Enhanced Recovery After Surgery

TED:

Thromboembolic Deterrent

AP:

Anteroposterior

SD:

Standard deviation

TTO:

Tibial Tubercle Osteotomy

LRR:

Lateral Retinacular Release

References

  1. Lange, J., & Haas, S. B. (2017). Correcting severe valgus deformity: taking out the knock. The Bone & Joint Journal, 99(1_Supple_A), 60–64

  2. Ranawat, A. S., Ranawat, C. S., Elkus, M., et al. (2005). Total knee arthroplasty for severe valgus deformity. Journal of Bone and Joint Surgery. American Volume, 87(Suppl 1), 271.

    Google Scholar 

  3. Keblish, P. A. (1991). The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clinical Orthopaedics and Related Research, (271), 52

  4. Rossi, R., et al. (2014). Total knee arthroplasty in the valgus knee. International Orthopaedics, 38, 273.

    Article  Google Scholar 

  5. Krackow, K. A., et al. (2002). Total knee arthroplasty in the valgus knee. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 10(1), 16–24.

    Article  Google Scholar 

  6. Xie, K., & Lyons, S. (2017). Soft tissue releases in Total Knee Arthroplasty for Valgus Deformities. Journal of Arthroplasty, 32(6), 1814–1818.

    Article  Google Scholar 

  7. Buechel, F. F. (1990). A sequential three-step lateral release for correcting fixed valgus knee deformities during total knee arthroplasty. Clinical orthopaedics and related research, 260, 170–175.

    Article  Google Scholar 

  8. Soffin, E. M., & Yadeau, J. T. (2016). Enhanced recovery after surgery for primary hip and knee arthroplasty: A review of the evidence. BJA: British Journal of Anaesthesia, 117(suppl_3), iii62–iii72

  9. Specogna, A. V., et al. (2007). Radiographic measures of knee alignment in patients with varus gonarthrosis: Effect of weightbearing status and associations with dynamic joint load. American Journal of Sports Medicine, 35(1), 65–70.

    Article  Google Scholar 

  10. Sarmah, et al. (2012). The radiological assessment of total and unicompartmental knee replacements. Journal of Bone and Joint Surgery. British Volume, 94(10), 1321–1329.

    Article  CAS  Google Scholar 

  11. Dexel, J., Kirschner, S., Günther, K., et al. (2014). Agreement between radiological and computer navigation measurement of lower limb alignment. Knee Surgery, Sports Traumatology, Arthroscopy, 22, 2721–2727.

    Article  Google Scholar 

  12. Krackow, K. A., Jones, M. M., & Teeny, S. M. (1991). Primary total knee arthroplasty in patients with fixed valgus deformity. Clinical Orthopaedics and Related Research, 273, 9–18.

    Google Scholar 

  13. Whiteside, L. A. (1999). Selective ligament release in total knee arthroplasty of the knee in valgus. Clinical Orthopaedics and Related Research, 367, 130–140.

    Article  Google Scholar 

  14. Kanamiya, T., Whiteside, L. A., Nakamura, T., Mihalko, W. M., Steiger, J., & Naito, M. (2002). Effect of selective lateral ligament release on stability in knee arthroplasty. Clinical Orthopaedics and Related Research, 1976–2007(404), 24–31.

    Article  Google Scholar 

  15. Boettner, F., Renner, L., Narbarte, D. A., Egidy, C., & Faschingbauer, M. (2016). Total knee arthroplasty for valgus osteoarthritis: the results of a standardized soft-tissue release technique. Knee Surgery, Sports Traumatology, Arthroscopy, 24(8), 2525–2531.

    Article  Google Scholar 

  16. McAuley, J. P., Collier, M. B., Hamilton, W. G., et al. (2008). Posterior cruciate-retaining total knee arthroplasty for valgus osteoarthritis. Clinical Orthopaedics and Related Research, 466, 2644–2649.

    Article  Google Scholar 

  17. Satish, B. R. J., et al. (2013). Efficacy and mid term results of lateral parapatellar approach without tibial tubercle osteotomy for primary total knee arthroplasty in fixed valgus knees. Journal of Arthroplasty, 28, 1751–1756.

    Article  Google Scholar 

  18. Sekiya, H., Takatoku, K., Takada, H., et al. (2014). Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee. European Journal of Orthopaedic Surgery Traumatology, 24, 111–115.

    Article  Google Scholar 

  19. Apostolopoulos, A. P., Nikolopoulos, D. D., Polyzois, I., Nakos, A., Liarokapis, S., Stefanakis, G., & Michos, I. V. (2010). Total knee arthroplasty in severe valgus deformity: Interest of combining a lateral approach with a tibial tubercle osteotomy. Orthopaedics & Traumatology: Surgery & Research, 96(7), 777–784.

    CAS  Google Scholar 

  20. Matsueda, M., et al. (1999). Soft tissue release in total knee arthroplasty: Cadaver study using knees without deformities. Clinical Orthopaedics and Related Research®, 366, 264-273

  21. Luring, C., Oczipka, F., Grifka, J., & Perlick, L. (2008). Thecomputer assisted sequential lateral soft-tissue release in total knee arthroplastyfor valgus knees. International Orthopaedics, 32(2), 229–235.

    Article  CAS  Google Scholar 

  22. Petersen, W., Rembitzki, I. V., Brüggemann, G.-P., et al. (2014). Anterior knee pain after total knee arthroplasty: A narrative review. International orthopaedics (SICOT), 38, 319–328.

    Article  Google Scholar 

  23. Malo, M., & Vince, K. G. (2003). The unstable patella after total knee arthroplasty: Etiology, prevention, and management. Journal of American Academy of Orthopaedic Surgeons, 11, 364–371.

    Article  Google Scholar 

  24. Hay, G. C. G., Kampshoff, J. J., & Kuster, M. S. M. (2010). Lateral subvastus approach with osteotomy of the tibial tubercle for total knee replacement: A 2-year prospective, randomised, blinded controlled trial. J Bone Joint Surg (Br), 92, 862–866.

    Article  CAS  Google Scholar 

  25. Chalidis, B. E., Ye, K., Sachinis, N. P., et al. (2014). Lateral parapatellar approach with tibial tubercle osteotomy for the treatment of noncorrectable valgus knee osteoarthritis. The Knee, 21, 204–208.

    Article  Google Scholar 

  26. Li, H., Ponzio, D. Y., Ong, A., Wei, W., Wang, B., Li, Z., & Zhou, D. (2020). Total knee arthroplasty for fixed valgus deformity correction using a modified lateral parapatellar approach. The Journal of Knee Surgery, 33(04), 372–377.

    Article  Google Scholar 

  27. Greenberg A, Kandel L, Liebergall M, Mattan Y, Rivkin G. Total Knee Arthroplasty for Valgus Deformity via a Lateral Approach: Clinical Results, Comparison to Medial Approach, and Review of Recent Literature [published online ahead of print, 2020 Mar 30]. J Arthroplasty. 2020

  28. Davis, J. A., Hogan, C., & Dayton, M. (2015). Postoperative coronal alignment after total knee arthroplasty: Does tailoring the femoral valgus cut angle really matter? Journal of Arthroplasty, 30(8), 1444–1448.

    Article  Google Scholar 

  29. Zhou, K., Ling, T., Xu, Y., et al. (2018). Effect of individualized distal femoral valgus resection angle in primary total knee arthroplasty: A systematic review and meta-analysis involving 1300 subjects. International Journal of Surgery, 50, 87–93.

    Article  Google Scholar 

  30. Metwaly, R. G., & Zakaria, Z. M. (2018). Single-incision double-plating approach in the management of isolated, closed osteoporotic distal femoral fractures. Geriatric Orthopaedic Surgery & Rehabilitation, 9, 2151459318799856.

    Article  Google Scholar 

  31. Bologna, M. G., Claudio, M. G., Shields, K. J., Katz, C., Salopek, T., & Westrick, E. R. (2019). Dual plate fixation results in improved union rates in comminuted distal femur fractures compared to single plate fixation18, 76–79.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Princess of Wales Hospital, Bridgend, UK

    Shaival S. Dalal, Amit Chandratreya, Keshav Singhal & Rahul Kotwal

Authors
  1. Shaival S. Dalal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amit Chandratreya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keshav Singhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rahul Kotwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shaival S. Dalal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed consent

For this type of study informed consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dalal, S.S., Chandratreya, A., Singhal, K. et al. Incidence of Soft-Tissue Releases, Clinical and Radiological Outcomes of Lateral Parapatellar Approach for Valgus Arthritic Knees: A 4-year Follow-up Study with A Review of Literature. JOIO 55 (Suppl 1), 38–45 (2021). https://doi.org/10.1007/s43465-020-00294-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-020-00294-1

Keywords

Search

Navigation