Total knee arthroplasty by subvastus with minimal oblique incision approach in treatment of valgus knee

doi:10.3877/cma.j.issn.1674-134X.2020.05.005

Abstract

Abstract:

Objective

To evaluate and compare the feasibility and early clinical results of minimally invasive total knee arthroplasty (TKA) by subvastus with minimal oblique cut (SMOC) approach for valgus knee.

Methods

From April 2015 to October 2017, 50 patients (60 knees) who underwent total knee arthroplasty with valgus knee arthroplasty in the Department of Joint Surgery of Qingdao University Affiliated Hospital were retrospectively analyzed. The patients with age over 85 years, previous knee surgery history and body mass index > 30 kg / m² were excluded. There were 13 males and 37 females, with age of (60 ± 8) years on average. Preoperative diagnosis included 30 cases of rheumatoid arthritis (52 knees), 15 cases of osteoarthritis (15knees) and three cases of traumatic arthritis (three knees). TKA via SMOC approach was performed in 31 knees of 25 patients (SMOC group), and TKA via traditional medial parapatellar approach was performed in 29 knees of 25 patients (parapatellar group). Preoperative demographics, hemoglobin(Hb), VAS, HSS score, range of motion (ROM), Lower limb force line, surgical time, lateral retinacular release, blood loss, Hb two days after surgery, drainage, blood transfusion rate, straight leg raising time, analgesic, postoperative lower limb strength and patellofemoral fit angle, visual analogue scale (VAS) at 24 h, Hospital for Special Surgery (HSS) score and range of motion (ROM) at one week, were recorded. The differences between the two groups were analyzed by independent sample t test or chi-square test.

Results

No complications like infection, loose of components were found during the follow-up. No difference existed in preoperative demographics (P>0.05). Valgus deformity was corrected after surgery in both group. Similar results were found between groups in operation time, blood loss, drainage, Hb at postoperative two days, transfusion, postoperative lower limb strength and patellofemoral fit angle (P>0.05). In SMOC group, better straight leg raising (t=10.500, P<0.01), lateral release rate (χ²=5.711, P<0.05) and analgesic were demonstrated(χ²=9.934, P<0.01). VAS score 24 h after operation in SMOC group was lower than that in parapatellar group (t=10.540, P<0.001), HSS score at one week after operation (t=8.110, P<0.001) and ROM one week after operation (t=2.085, P<0.05) in SMOC group were lower than those in parapatellar group (t=10.540, P<0.001).

Conclusion

Valgus knee can be treated successfully by TKA through SMOC approach, with less lateral retinaculum faster short-term recovery effect compared with traditional parapatellar approach.

Key words: Osteoarthritis, Arthroplasty, Knee, Arthritis, rheumatoid

Haining Zhang, Yi Sun, Changrong Ding, Yingzhen Wang. Total knee arthroplasty by subvastus with minimal oblique incision approach in treatment of valgus knee[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(05): 546-551.

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Figures/Tables 6

References 21

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分组	例数	年龄[岁，(±s)]	男性占比(%)	BMI[kg/m²，(±s)]	Hb含量[g/L，(±s)]	VAS评分(±s)	HSS评分(±s)	外翻角度[°，(±s)]	术前ROM[°，(±s)]
SMOC组	25	59.3±8.3	24.0	24.3±5.0	124.4±14.1	5.5±1.7	41.5±9.3	11.3±5.6	105.5±12.3
髌旁组	25	60.6±8.4	28.0	25.4±5.0	122.3±13.6	5.4±1.4	39.9±7.7	10.0±4.8	108.41±13.3
统计值		t＝0.884	χ²＝0.104	t＝0.707	t＝0.505	t＝0.185	t＝0.831	t＝0.640	t＝0.565
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

分组	例数	年龄[岁，(±s)]	男性占比(%)	BMI[kg/m²，(±s)]	Hb含量[g/L，(±s)]	VAS评分(±s)	HSS评分(±s)	外翻角度[°，(±s)]	术前ROM[°，(±s)]
SMOC组	25	59.3±8.3	24.0	24.3±5.0	124.4±14.1	5.5±1.7	41.5±9.3	11.3±5.6	105.5±12.3
髌旁组	25	60.6±8.4	28.0	25.4±5.0	122.3±13.6	5.4±1.4	39.9±7.7	10.0±4.8	108.41±13.3
统计值		t＝0.884	χ²＝0.104	t＝0.707	t＝0.505	t＝0.185	t＝0.831	t＝0.640	t＝0.565
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

分组	例数	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流量[ml，(±s)]	辅助镇痛药物使用(%)	术后2 d Hb[g/L，(±s)]	外侧支持带松解率(%)	直腿抬高时间[d，(±s)]
SMOC组	25	82.3±15.2	152.7±51.2	88.3±35.5	18.8	102.6±11.3	64.0	1.0±0.6
髌旁组	25	80.4±14.5	155.4±52.2	90.4±38.6	62.5	98.9±10.0	93.1	3.1±0.8
统计值		t＝0.452	t＝0.185	t＝0.200	χ²＝9.934	t＝1.226	χ²＝5.711	t＝10.500
P值		>0.05	>0.05	>0.05	<0.01	>0.05	<0.05	<0.001

分组	例数	手术时间[min，(±s)]	术中出血量[ml，(±s)]	术后引流量[ml，(±s)]	辅助镇痛药物使用(%)	术后2 d Hb[g/L，(±s)]	外侧支持带松解率(%)	直腿抬高时间[d，(±s)]
SMOC组	25	82.3±15.2	152.7±51.2	88.3±35.5	18.8	102.6±11.3	64.0	1.0±0.6
髌旁组	25	80.4±14.5	155.4±52.2	90.4±38.6	62.5	98.9±10.0	93.1	3.1±0.8
统计值		t＝0.452	t＝0.185	t＝0.200	χ²＝9.934	t＝1.226	χ²＝5.711	t＝10.500
P值		>0.05	>0.05	>0.05	<0.01	>0.05	<0.05	<0.001

分组	例数	下肢力线	屈膝30°适合角
SMOC组	25	2.2±4.2	16.5±0.7
髌旁组	25	2.0±5.1	16.3±0.8
t值		0.151	0.941
P值		>0.05	>0.05

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