The consequences of lateral release in total knee replacement: a review of over 1000 knees with follow up between 5 and 11 years.
BACKGROUND
The relationship between lateral release in total knee arthroplasty and subsequent patello-femoral problems is contentious. Variable rates of instability, patella fracture and other complications have been demonstrated after lateral release. Significant measures have been taken by some surgeons to avoid a lateral release. We wished to determine whether lateral release was detrimental or beneficial in terms of mid- to long- term patellofemoral problems.


METHODS
We examined 1071 total knee arthroplasties with a follow-up of 5 to 11 years to determine the longer-term consequences of lateral release. Lateral release was performed as clinically indicated after a 'no thumbs' assessment in 51% of cases. The knees requiring a lateral release had lower pre-operative Hospital for Special Surgery (HSS) scores and demonstrated a greater improvement in post-operative HSS scores.


RESULTS
The difference in HSS scores, between the groups, was significantly less post-operatively than prior to surgery. Overall, we had a high incidence of lateral release (51%), but low fracture rate (1.2%), and very low instability rate (0.6%). Only three surgeries were required for patello-femoral problems.


CONCLUSIONS
This study suggests that any negative consequences of lateral release are minimal and we recommend lateral release continue to be performed as clinically indicated.
Weber
Andrew B
AB
Advanced Orthopaedic Centers, Henrico Doctor's Hospital-Parham, 7650 Parham Road, Richmond, VA 23294, USA.
Worland
Richard L
RL
Jessup
Douglas E
DE
Van Bowen
Jacob
J
Keenan
Jonathan
J
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000453:epidemiology / Q000209:etiology; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D010027:Osteotomy / Q000379:methods; D010329:Patella / Q000293:injuries; D011184:Postoperative Period; D012086:Reoperation; D016138:Walking