Lateral Parapatellar Approach Without Tibial Tubercle Osteotomy for Fixed Valgus Deformity Correction in Total Knee Arthroplasty.

Abstract

The lateral parapatellar approach provides direct access to the pathological area in a valgus knee deformity and allows sequential titrated release of contracted lateral soft tissues during total knee arthroplasty. Differentiate the flexible and fixed components of the valgus deformity by clinical and radiographic examination. Open the knee joint from the lateral side by coronal z-plasty of the lateral retinaculum, oblique lateral tenotomy of the quadriceps tendon, and iliotibial band release. Perform a quadriceps snip and expose the knee joint. Make proximal tibial and distal femoral cuts in appropriate alignment. A rectangular extension gap is the goal. Determine the femoral component size and femoral rotation, and balance the flexion gap. Confirm tibial rotational alignment, fix the components, and assess patellar tracking. Perform closure of the prosthetic joint with expanded lateral structures. Between 2003 and 2009, thirty-two knees with clinical valgus deformity of >10° underwent total knee arthroplasty with an expansile lateral arthrotomy technique¹¹.IndicationsContraindicationsPitfalls & Challenges.