title: A prospective randomized study in 20 patients undergoing bilateral TKA comparing midline incision to anterolateral incision.
abstract: BACKGROUND
  Lateral flap numbness is a known side-effect of midline skin incision in total knee arthroplasty (TKA) and a cause of patient dissatisfaction. Anterolateral incision is an alternative approach which preserves the infrapatellar branches of the saphenous nerve and avoids numbness. Studies have compared both incisions, but in different patients. However, different patients may assess the same sensory deficit dissimilarly, because of individual variations in anatomy and healing responses. We compared the two incisions in the same patient at the same time, using an anterolateral incision on one knee and a midline incision on the other knee in simultaneous bilateral TKA. Other surgical steps including medial arthrotomy were idential. We also correlated subjective and objective findings.
  
  
  METHODS
  Twenty patients were prospectively randomized. Sensory loss and skin healing were assessed at 6, 12 and 52 weeks. Subjective preference for the knee with less numbness was charted on Wald's Sequential Probability Ratio Test. Sensation scores for touch, vibration, static and moving two-point discrimination were measured. Scar healing was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Functional scores were measured.
  
  
  RESULTS
  A statistically significant difference favoring knees with anterolateral incision was observed in patient preference at all assessment points and this correlated with sensation scores. A statistically significant difference was observed in POSAS score favoring knees with anterolateral incision at 6 and 12 weeks which became statistically insignificant at 1 year. Functional scores remained comparable.
  
  
  CONCLUSIONS
  We recommend anterolateral incision as a safe and effective method to circumvent the problem of lateral flap numbness with midline incision.
  
  
  METHODS
  I.
authors.affiliation: Lilavati Hospital, A-791, Bandra Reclamation, Bandra (W), Mumbai, 400050, Maharashtra, India. drmaniar@jointspeciality.com.|Breach Candy hospital, 60 A, Bhulabhai Desai Road, Mumbai, 400026, Maharashtra, India. drmaniar@jointspeciality.com.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Maniar
authors.affiliation: Department of Orthopedics, Padamshree D Y Patil Medical College, Sector 7; Nerul, Navi Mumbai, 400706, Maharashtra, India.
authors.forename: Tushar
authors.initials: T
authors.lastname: Singhi
authors.affiliation: Lilavati Hospital, A-791, Bandra Reclamation, Bandra (W), Mumbai, 400050, Maharashtra, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Nanivadekar
authors.affiliation: , 51-B, Nook Apartment, S.V. Road, North Avenue Junction, Santacruz (W), Mumbai, 400054, Maharashtra, India.
authors.forename: Parul R
authors.initials: PR
authors.lastname: Maniar
authors.affiliation: Agarwal Ramkrishna Care Hospital, Raipur, 492001, Chattisgarh, India.
authors.forename: Jaivardhan
authors.initials: J
authors.lastname: Singh
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011446:Prospective Studies; D013524:Surgical Flaps / Q000294:innervation; D000072836:Surgical Wound / Q000150:complications; D014945:Wound Healing
keywords: Anterolateral incision; Flap numbness; Scar healing