title: Total knee arthroplasty in valgus knees using minimally invasive medial-subvastus approach.
abstract: BACKGROUND
  An ideal approach for valgus knees must provide adequate exposure with minimal complications due to approach per se. Median parapatellar approach is most commonly used approach in TKA including valgus knees. A medial subvastus approach is seldom used for valgus knees and has definite advantages of maintaining extensor mechanism integrity and minimal effect on patellar tracking. The present study was conducted to evaluate outcomes of total knee arthroplasty (TKA) and efficacy of subvastus approach in valgus knees in terms of early functional recovery, limb alignment and complications.
  
  
  METHODS
  We retrospectively reviewed 112 knees with valgus deformity between January 2006 and December 2011. All patients were assessed postoperatively for pain using Visual Analog Scale (VAS) and quadriceps recovery in form of time to active straight leg raising (SLR) and staircase competency and clinical outcomes using American Knee Society (AKS) score and radiographic evaluation with average followup of 40 months (range 24-84 months).
  
  
  RESULTS
  The mean VAS on postoperative day (POD) 1 and POD2 at rest was 2.73 and 2.39, respectively and after mobilization was 3.28 and 3.08, respectively (P < 0.001). The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h. The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001). The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°-35°) to 5° (range 3°-9°) valgus (P < 0.001).
  
  
  CONCLUSIONS
  Mini-subvastus quadriceps approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.
authors.affiliation: Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India.
authors.forename: Nilen Amulak
authors.initials: NA
authors.lastname: Shah
authors.affiliation: Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India; Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-Gu, Seongnam-Si, Korea.
authors.forename: Nimesh Prakash
authors.initials: NP
authors.lastname: Jain
keywords: Arthroplasty; Functional outcomes; knee; osteoarrthritis; quadriceps muscle; replacement; subvastus approach; total knee arthroplasty; valgus deformity