M P Arnold1, N F Friederich2, H Widmer, W Müller2. 1. Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital Bruderholz, CH-4101, Bruderholz, Schweiz. arnold_mp@hotmail.com. 2. Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital Bruderholz, CH-4101, Bruderholz, Schweiz.
Abstract
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 median 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 tokal 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%).
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 median 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 tokal 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%).
Entities:
Keywords:
Lateral approach to the knee; Osteotomy of the tibial tuberosity; Subvastus approach; Total knee replacement