title: Hypesthesia after anterolateral versus midline skin incision in TKA: a randomized study.
abstract: BACKGROUND
  The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous hypesthesia and neuroma formation.
  
  
  OBJECTIVE
  We asked whether an anterolateral skin incision to the knee would decrease the area of skin hypesthesia and associated postoperative discomfort.
  
  
  METHODS
  We randomized 69 knees to receive a TKA through either a midline or an anterolateral skin incision. We assessed skin sensitivity by application of the Semmes-Weinstein monofilament at 13 reference points at 6 weeks and 6 and 12 months postoperatively. The area of hypesthesia was measured using Mesurim Pro 9(®) software. Patient knee ROM, Knee Injury and Osteoarthritis Outcome Score (KOOS), and WOMAC clinical score also were assessed.
  
  
  RESULTS
  The area of hypesthesia was less after an anterolateral compared with a midline incision up to 1 year after surgery: the areas of hypesthesia were, respectively, 32 cm(2) versus 76 cm(2) at 6 weeks, 14 cm(2) versus 29 cm(2) at 6 months, and 7 cm(2) versus 19 cm(2) at 1 year. Clinical scores and knee ROM were similar in both groups at each followup. At 1 year, in the entire group we observed a correlation between a smaller area of paresthesia and better WOMAC and KOOS scores and greater knee flexion.
  
  
  CONCLUSIONS
  Compared with the midline skin incision, the anterolateral incision is associated with fewer sensory disturbances and appears to be a reasonable alternative in TKA.
  
  
  METHODS
  Level I, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Rangueil Hospital Center, Toulouse, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Laffosse
authors.forename: Anna
authors.initials: A
authors.lastname: Potapov
authors.forename: Michel
authors.initials: M
authors.lastname: Malo
authors.forename: Martin
authors.initials: M
authors.lastname: Lavigne
authors.forename: Pascal-André
authors.initials: PA
authors.lastname: Vendittoli
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D006941:Hyperesthesia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007431:Intraoperative Complications; D007718:Knee Injuries / Q000503:physiopathology; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D020127:Recovery of Function