Early results of total knee arthroplasty performed through the midvastus approach

Amaç: Total diz artroplastisinde (TDA) midvastus yaklaşımla yapılan cerrahi uygulamalarımızın erken dönem sonuçları değerlendirildi. Çalışma planı: Bu çalışmada, derece 4 gonartroz nedeniyle aynı cerrah tarafından midvastus yaklaşımla TDA uygulanan 42 hastanın (29 kadın, 13 erkek; ort. yaş 69; dağılım 54-82) 48 dizi geriye dönük olarak incelendi. Ameliyat öncesinde 40 olguda (%95.2) primer osteoartrit, iki olguda (%4.8) romatoid artrit vardı. Tüm olgularda posterior stabilizan tipte, çimentolu, sabit insertli protez kullanıldı. Yedi dizde (%14.6) patella yüzey değişimi uygulandı. Tüm dizler ameliyattan önce ve son kontrolde Diz Derneği’nin diz ve fonksiyon puanlarıyla değerlendirildi. Ameliyat öncesi ve sonrası radyografik değerlendirmeler iki yönlü grafiler çekilerek Diz Derneği TDA radyografik değerlendirme ve skorlama sistemine göre yapıldı. Ortalama takip süresi 26 ay (dağılım 12-49 ay) idi. Sonuçlar: Diz skoru ortalaması ameliyat öncesinde 49.0±9.3 iken, ameliyat sonrasında anlamlı yükselişle 87.5±9.9 bulundu (p=0.000). Ameliyat öncesinde 48.8±9.9 olan diz fonksiyon puanı ameliyat sonrasında 79.6±14.0’e yükseldi (p=0.000). Diz puanında ortalama artış 38.5, fonksiyon puanında artış 30.8 idi. Diz skoru 46 dizde (%95.8), diz fonksiyon skoru ise 42 dizde (%87.5) mükemmel veya iyi olarak değerlendirildi. Ameliyat öncesi diz fleksiyon açıklığı ortalama 84.3±14.7° iken, ortalama 28.6° artışla son takipte 112.9±11.9° ölçüldü (p=0.000). Her iki dizde gonartroz bulunan olgular içinde, iki taraflı ameliyat geçirenlerde diz fonksiyon puanı (90.0±11.5), tek taraflı ameliyat geçirenlere (78.8±10.8) göre anlamlı derecede yüksek bulundu (p=0.007). Ameliyat sırasında hiçbir olguda patellada yönelim kusuru saptanmadı; bu nedenle, lateral retinaküler gevşetmeye gereksinim duyulmadı. Ameliyat sonrası klinik ve radyografik değerlendirmelerde herhangi bir instabilite veya gevşeme bulgusuna rastlanmadı. Patellası değişen olgularda, patellada klinik ve radyografik olarak gevşeme ve osteoliz bulgusuna rastlanmadı. Protezlerin dizilimi veya pozisyonunda hiçbir değişiklik gözlenmedi. Hiçbir olguda nörovasküler yaralanma olmadı. Bir olgunun dizinde erken enfeksiyon gelişmesi üzerine iki aşamalı revizyon uygulandı ve sonuç başarısız olarak değerlendirildi. Çıkarımlar: Çalışmamızda midvastus yaklaşımla TDA uygulanan olgularda ameliyat sırasında uygun patellar dizilim sağlandığı için lateral retinaküler gevşetmeye gereksinim duyulmamış ve erken dönemde klinik ve radyografik olarak başarılı sonuçlar elde edilmiştir.

Midvastus yaklaşımla yapılan total diz artroplastisinin erken dönem sonuçları

Objectives: The aim of this study was to evaluate the early results of total knee arthroplasty (TKA) performed through the midvastus approach. Methods: This retrospective study included 48 knees of 42 patients (29 females, 13 males; mean age 69 years; range 54 to 82 years) who underwent TKA for grade 4 knee osteoarthritis. All TKA operations were performed by the same orthopedic surgeon through the midvastus approach. Preoperatively, 40 patients (95.2%) had primary osteoarthritis, and two patients (4.8%) had rheumatoid arthritis. In all cases, a posterior stabilized cemented prosthesis with a fixed insert was used. Patellar resurfacing was performed in seven knees (14.6%). All the knees were rated according to the Knee Society knee and function scores before surgery and at the final follow-up. Postoperative radiographic evaluations were performed on anteroposterior and lateral radiographs according to The Knee Society TKA Roentgenographic Evaluation and Scoring System. The mean follow-up period was 26 months (range 12 to 49 months). Results: The mean knee score significantly improved from 49.0±9.3 preoperatively to 87.5±9.9 postoperatively (p=0.000). The corresponding increase in the knee function score was from 48.8±9.9 to 79.6±14.0 (p=0.000). The mean increases in the knee and function scores were 38.5 and 30.8 points, respectively. The knee and function scores were excellent or good in 46 knees (95.8%) and 42 knees (87.5%), respectively. The mean knee flexion significantly increased by 28.6°, from 84.3±14.7° preoperatively to 112.9±11.9° postoperatively (p=0.000). Among patients with bilateral osteoarthritis, the knee function scores were significantly higher in patients who had undergone bilateral versus unilateral TKA (90.0±11.5 and 78.8±10.8, respectively; p=0.007). None of the patients had patellar tracking abnormality intraoperatively; thus, there was no need for lateral retinacular release. Postoperative clinical and radiographic assessments showed no signs of instability or loosing. Clinical and radiographic loosening of the patella and osteolysis were not observed in patients who had undergone patellar replacement. No changes were observed in the tracking and position of the protheses. Neurovascular injury did not occur. One patient who developed early infection of the knee that required a two-stage revision was assessed as failure. Conclusion: In our study, lateral retinacular release was not needed due to achievement of proper patellar tracking in TKA operations with the midvastus approach, and satisfactory clinical and radiographic results were obtained.

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Acta Orthopaedica et Traumatologica Turcica-Cover
  • ISSN: 1017-995X
  • Başlangıç: 2015
  • Yayıncı: Türk Ortopedi ve Travmatoloji Derneği
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