[Anterolateral Approach of TKA.].
Author describes anterolateral approach to the knee joint that he has been using since 1998 for total knee arthroplasty in more severe deformities fixed in valgus position. He points out the strengths and weaknesses as compared to the classic antero-medial approach. Anterolateral approach in a valgus knee is more physiological, releasing of longitudinal retinacula of the pattela including retinaculum transversum patellae laterale is part of the approach, it allows full closing of the surgical wound in all layers, it has a favourable impact on the restoration of normal range of movement of patella and allows to balance the knee joint in valgus and semiflexion in a more simple way. Last but not least, it disturbs less the blood supply of patella than the medial approach (which is in case of valgus knee almost always connected with discission of lateral retinacula) and thus reduces the risk of the onset of avascular necrosis of patella. The disadvantage of this approach is a more difficult dislocation of patella and extension apparatus medially with a simultaneous flexion of the knee which is necessary for bone resections. The author solves this situation by a partial detachment of tibial tuberosity ("feathering") without the necessity of the fixation of the tibial tuberosity by osteosynthetic material. Between January 1998 and October 1998 the author perfomed by this approach eight arthroplasties in knees with severe valgus deformation with a good functional result without signs of patella subluxation. The implants used were standard cemented components of the knee joint of Johnson & Johnson and BIOMET. Key words: TKR, surgical approach, patella subluxation, lateral release.
Koudela
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Ortopedická klinika LF UK, Plzen.