Lateral Parapatellar Approach Without Tibial Tubercle Osteotomy for Fixed Valgus Deformity...
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Transcript of Lateral Parapatellar Approach Without Tibial Tubercle Osteotomy for Fixed Valgus Deformity...
Lateral Parapatellar Approach Without Tibial Tubercle Osteotomy
for Fixed Valgus Deformity Correction in Total Knee Arthroplasty by
Bhava R.J. Satish, Jutty C. Ganesan, Prakash Chandran, Praveen L.
Basanagoudar, and Damodarasamy Balachandar JBJS Essent Surg Tech
Volume 3(4):e20 October 9, 2013 2013 by The Journal of Bone and
Joint Surgery, Inc. Bhava R.J. Satish et al. JBJS Essent Surg Tech
2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Assess surgical
valgus, which is the residual valgus of an extended knee when
manual varus strain is applied with the patient under anesthesia.
Assess surgical valgus, which is the residual valgus of an extended
knee when manual varus strain is applied with the patient under
anesthesia. Clinical valgus is the maximal deformity seen on
weight-bearing radiographs. Bhava R.J. Satish et al. JBJS Essent
Surg Tech 2013;3:e20 2013 by The Journal of Bone and Joint Surgery,
Inc. Separate the lateral retinaculum and capsule complex into two
layers (coronal z-plasty).
Separate the lateral retinaculum and capsule complex into two
layers (coronal z-plasty). This is a right knee with the patients
head on the left side of the figure and the foot on the right side.
(Figure on right reproduced, with permission from Elsevier, from:
Satish BR, Ganesan JC, Chandran P, Basanagoudar PL, Balachandar D.
Efficacy and Mid Term Results of Lateral Parapatellar Approach
Without Tibial Tubercle Osteotomy for Primary Total Knee
Arthroplasty in Fixed Valgus Knees. J Arthroplasty May 20. Bhava
R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by The
Journal of Bone and Joint Surgery, Inc. Graphic representation of
Fig. 2-A.
Graphic representation of Fig. 2-A. (Reproduced, with permission
from Elsevier, from: Satish BR, Ganesan JC, Chandran P,
Basanagoudar PL, Balachandar D. Efficacy and Mid Term Results of
Lateral Parapatellar Approach Without Tibial Tubercle Osteotomy for
Primary Total Knee Arthroplasty in Fixed Valgus Knees. J
Arthroplasty May 20. Bhava R.J. Satish et al. JBJS Essent Surg Tech
2013;3:e20 2013 by The Journal of Bone and Joint Surgery, Inc.
Include the retropatellar fat pad in the lateral retinacular
flap.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Release the iliotibial
band from the Gerdy tubercle.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Expose the knee with
flexion after the quadriceps snip (arrow) and patellar
eversion.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Release the
anterolateral aspect of the capsule adherent to the proximal part
of the tibia.
Release the anterolateral aspect of the capsule adherent to the
proximal part of the tibia. Note the release of the iliotibial band
from the Gerdy tubercle and inclusion of the fat pad with part of
the lateral meniscus in the lateral flap. Bhava R.J. Satish et al.
JBJS Essent Surg Tech 2013;3:e20 2013 by The Journal of Bone and
Joint Surgery, Inc. Subluxate the tibia forward by hyperflexing the
knee and internally rotating the leg.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Make the proximal
tibial cut perpendicular to the tibial axis.
Make the proximal tibial cut perpendicular to the tibial axis. Note
the use of a left-sided cutting block for the lateral parapatellar
approach to the right knee. Bhava R.J. Satish et al. JBJS Essent
Surg Tech 2013;3:e20 2013 by The Journal of Bone and Joint Surgery,
Inc. Make a distal femoral cut in 3 to 5 of valgus in relation to
the anatomical axis.
Make a distal femoral cut in 3 to 5 of valgus in relation to the
anatomical axis. The cutting block may not touch the lateral
femoral condyle, and there is minimal or no removal of bone from
the lateral condyle. Bhava R.J. Satish et al. JBJS Essent Surg Tech
2013;3:e20 2013 by The Journal of Bone and Joint Surgery, Inc.
Perform extension gap balancing with the block.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Place the proper size
femoral 4-in-1 cutting block after confirming rotation.
Place the proper size femoral 4-in-1 cutting block after confirming
rotation. Align the posterior margin of the block parallel to the
proximal tibial cut surface. Bhava R.J. Satish et al. JBJS Essent
Surg Tech 2013;3:e20 2013 by The Journal of Bone and Joint Surgery,
Inc. Perform flexion gap balancing with the block.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Align the tibial
rotation with the trial femoral component and ankle center using an
external alignment rod. Align the tibial rotation with the trial
femoral component and ankle center using an external alignment rod.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Fix the original
components and reduce the joint.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Assess the patellar
tracking and the quadriceps snip repair.
Assess the patellar tracking and the quadriceps snip repair. Note
the exceptionally good patellar tracking on this image. Bhava R.J.
Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by The Journal
of Bone and Joint Surgery, Inc. The quadriceps snip repair and good
patellar tracking in another knee with the superficial retinacular
layer attached to the lateral border of the patella. The quadriceps
snip repair and good patellar tracking in another knee with the
superficial retinacular layer attached to the lateral border of the
patella. Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20
2013 by The Journal of Bone and Joint Surgery, Inc. Flex the knee
70 to 90 to start the joint closure.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Identify the previously
separated coronal z-plasty layers of the lateral reticulum and
capsular complex. Identify the previously separated coronal
z-plasty layers of the lateral reticulum and capsular complex.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Suture the free margins
of the z-plasty layers.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Depending on the defect
on the lateral side, suture the free edges or overlap the edges of
the z-plasty layers. Depending on the defect on the lateral side,
suture the free edges or overlap the edges of the z-plasty layers.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. Note the lateral
expansion area at the completion of the z-plasty closure.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. In knees with a mild
deformity, suture the proximal lateral tibial sleeve to the
patellar tendon.
Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by
The Journal of Bone and Joint Surgery, Inc. In knees with a severe
deformity, use the lateral fad pad to close the proximal-lateral
tibial area.
In knees with a severe deformity, use the lateral fad pad to close
the proximal-lateral tibial area. The white asterisks indicate the
area of lateral expansion. (Reproduced, with permission from
Elsevier, from: Satish BR, Ganesan JC, Chandran P, Basanagoudar PL,
Balachandar D. Efficacy and Mid Term Results of Lateral
Parapatellar Approach Without Tibial Tubercle Osteotomy for Primary
Total Knee Arthroplasty in Fixed Valgus Knees. J Arthroplasty May
20. Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013
by The Journal of Bone and Joint Surgery, Inc. Preoperative
clinical photograph and anteroposterior radiograph of a patient
with windblown knees.
Preoperative clinical photograph and anteroposterior radiograph of
a patient with windblown knees. The defect is seen on the lateral
tibial condyle of the left valgus knee. (Reproduced, with
permission from Elsevier, from: Satish BR, Ganesan JC, Chandran P,
Basanagoudar PL, Balachandar D. Efficacy and Mid Term Results of
Lateral Parapatellar Approach Without Tibial Tubercle Osteotomy for
Primary Total Knee Arthroplasty in Fixed Valgus Knees. J
Arthroplasty May 20. Bhava R.J. Satish et al. JBJS Essent Surg Tech
2013;3:e20 2013 by The Journal of Bone and Joint Surgery, Inc.
Intraoperative photographs showing a peripheral defect on the
posterior aspect of the lateral tibial condyle, which was
reconstructed with bone graft and screws. Intraoperative
photographs showing a peripheral defect on the posterior aspect of
the lateral tibial condyle, which was reconstructed with bone graft
and screws. (Reproduced, with permission from Elsevier, from:
Satish BR, Ganesan JC, Chandran P, Basanagoudar PL, Balachandar D.
Efficacy and Mid Term Results of Lateral Parapatellar Approach
Without Tibial Tubercle Osteotomy for Primary Total Knee
Arthroplasty in Fixed Valgus Knees. J Arthroplasty May 20. Bhava
R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by The
Journal of Bone and Joint Surgery, Inc. Postoperative clinical
photograph and anteroposterior radiograph made five years after a
right total knee arthroplasty was performed with a medial
arthrotomy and a left total knee arthroplasty was performed through
a lateral approach. Postoperative clinical photograph and
anteroposterior radiograph made five years after a right total knee
arthroplasty was performed with a medial arthrotomy and a left
total knee arthroplasty was performed through a lateral approach.
The graft incorporated well with maintenance of femorotibial
alignment. (Reproduced, with permission from Elsevier, from: Satish
BR, Ganesan JC, Chandran P, Basanagoudar PL, Balachandar D.
Efficacy and Mid Term Results of Lateral Parapatellar Approach
Without Tibial Tubercle Osteotomy for Primary Total Knee
Arthroplasty in Fixed Valgus Knees. J Arthroplasty May 20. Bhava
R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013 by The
Journal of Bone and Joint Surgery, Inc. Anteroposterior radiograph,
made with the patient in a lying position, and preoperative
clinical photograph, made with the patient standing, showing severe
dysplastic valgus deformity of both knees. Anteroposterior
radiograph, made with the patient in a lying position, and
preoperative clinical photograph, made with the patient standing,
showing severe dysplastic valgus deformity of both knees.
(Reproduced, with permission from Elsevier, from: Satish BR,
Ganesan JC, Chandran P, Basanagoudar PL, Balachandar D. Efficacy
and Mid Term Results of Lateral Parapatellar Approach Without
Tibial Tubercle Osteotomy for Primary Total Knee Arthroplasty in
Fixed Valgus Knees. J Arthroplasty May 20. Bhava R.J. Satish et al.
JBJS Essent Surg Tech 2013;3:e20 2013 by The Journal of Bone and
Joint Surgery, Inc. Preoperative clinical photograph of the patient
lying supine.
Preoperative clinical photograph of the patient lying supine. The
deformity measured 60 on the right side and 55 on the left side.
(Reproduced, with permission from Elsevier, from: Satish BR,
Ganesan JC, Chandran P, Basanagoudar PL, Balachandar D. Efficacy
and Mid Term Results of Lateral Parapatellar Approach Without
Tibial Tubercle Osteotomy for Primary Total Knee Arthroplasty in
Fixed Valgus Knees. J Arthroplasty May 20. Bhava R.J. Satish et al.
JBJS Essent Surg Tech 2013;3:e20 2013 by The Journal of Bone and
Joint Surgery, Inc. Postoperative clinical photograph and
anteroposterior radiograph made 3.4 years postoperatively.
Postoperative clinical photograph and anteroposterior radiograph
made 3.4 years postoperatively. (Reproduced, with permission from
Elsevier, from: Satish BR, Ganesan JC, Chandran P, Basanagoudar PL,
Balachandar D. Efficacy and Mid Term Results of Lateral
Parapatellar Approach Without Tibial Tubercle Osteotomy for Primary
Total Knee Arthroplasty in Fixed Valgus Knees. J Arthroplasty May
20. Bhava R.J. Satish et al. JBJS Essent Surg Tech 2013;3:e20 2013
by The Journal of Bone and Joint Surgery, Inc. Axial view of both
knees showing good patellar tracking.
Axial view of both knees showing good patellar tracking.
(Reproduced, with permission from Elsevier, from: Satish BR,
Ganesan JC, Chandran P, Basanagoudar PL, Balachandar D. Efficacy
and Mid Term Results of Lateral Parapatellar Approach Without
Tibial Tubercle Osteotomy for Primary Total Knee Arthroplasty in
Fixed Valgus Knees. J Arthroplasty May 20. Bhava R.J. Satish et al.
JBJS Essent Surg Tech 2013;3:e20 2013 by The Journal of Bone and
Joint Surgery, Inc. Attachment of the tendon of the popliteus just
proximal to the lateral femoral condylar articular surface.
Attachment of the tendon of the popliteus just proximal to the
lateral femoral condylar articular surface. Bhava R.J. Satish et
al. JBJS Essent Surg Tech 2013;3:e20 2013 by The Journal of Bone
and Joint Surgery, Inc.