Results of computer assisted mini-incision subvastus approach for total knee arthroplasty.
BACKGROUND
Mini-incision subvastus approach is soft tissue preservation of the knee. Advantages of the mini-incision subvastus approach included reduced blood loss, reduced pain, self rehabilitation and faster recovery. However, the improved visualization, component alignment, and more blood preservation have been debatable to achieve the better outcome and preventing early failure of the Total Knee Arthroplasty (TKA). The computer navigation has been introduced to improve alignment and blood loss. The purpose of this study was to evaluate the short term outcomes of the combination of computer assisted mini-incision subvastus approach for Total Knee Arthroplasty (CMS-TKA).


METHODS
A prospective case series of the initial 80 patients who underwent computer assisted mini-incision subvastus approach for CMS-TKA from January 2007 to October 2008 was carried out. The patients' conditions were classified into 2 groups, the simple OA knee (varus deformity was less than 15 degree, BMI was less than 20%, no associated deformities) and the complex deformity (varus deformity was more than 15 degrees, BMI more was than 20%, associated with flexion contractor). There were 59 patients in group 1 and 21 patients in group 2. Of the 80 knees, 38 were on the left and 42 on the right.


RESULTS
The results of CMS-TKA [the mean (range)] in group 1: group 2 were respectively shown as the incision length [10.88 (8-13): 11.92 (10-14], the operation time [118 (111.88-125.12): 131 (119.29-143.71) minutes, lateral releases (0 in both groups), postoperative range of motion in flexion [94.5 (90-100): 95.25 (90-105) degree] and extension [1.75 (0-5): 1.5 (0-5) degree] Blood loss in 24 hours [489.09 (414.7-563.48): 520 (503.46-636.54) ml] and blood transfusion [1 (0-1) unit? in both groups], Tibiofemoral angle preoperative [Varus = 4 (varus 0-10): Varus = 17.14 (varus 15.7-18.5) degree, Tibiofemoral angle postoperative [Valgus = 1.38 (Valgus 0-4): Valgus = 2.85 (valgus 2.1-3.5) degree], Tibiofemoral angle outlier (85% both groups), and Knee society score preoperative and postoperative [64.6 (59.8-69.4) and 93.7 (90.8-96.65)]: 69 (63.6-74.39) 92.36 (88.22-96.5)]. The complications found in both groups were similar. No deep vein thrombosis, no fracture at both femur and tibia, no vascular injury, and no pin tract pain or infection was found in both groups.


CONCLUSIONS
The computer assisted CMS-TKA) is one of the appropriate procedures for all varus deformity, no limitation with the associated bone loss, flexion contractor, BMI, except the fixed valgus deformity. To ensure the clinical outcomes, multiple key steps were considered as the appropriate techniques for this approach which included the accurate registration, precision bone cut and ligament balances, and the good cement techniques.
Turajane
Thana
T
Department of Orthopedic Surgery, Police General Hospital, Bangkok, Thailand.
Larbpaiboonpong
Viroj
V
Kongtharvonskul
Jatupon
J
Maungsiri
Samart
S
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome