Top

Archives of Orthopaedic and Trauma Surgery

Published in:

Open Access 21-10-2023 | Joint Infection | Knee Arthroplasty

Lateral versus medial approach for total knee arthroplasty for valgus knee deformity shows comparable functional outcomes, hip–knee–ankle angle values, and complication rates: a meta-analysis of comparative studies

Authors: Michele Mercurio, Giorgio Gasparini, Olimpio Galasso, Filippo Familiari, Erminia Cofano, Valentina Sanzo, Gianluca Ciolli, Katia Corona, Simone Cerciello

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2024

Abstract

Introduction

The aim of this meta-analysis of comparative studies was to update the current evidence on functional and radiographic outcomes and complications between medial and lateral approaches for total knee arthroplasty (TKA) for valgus knee deformity.

Materials and methods

The PubMed, MEDLINE, Scopus, and the Cochrane Central databases were used to search keywords and a total of ten studies were included. The methodological quality of the included studies was assessed. Data extracted for quantitative analysis included the Knee Society score (KSS), range of motion (ROM), surgical time, hip–knee–ankle angle (HKA), and number and types of complications. Random- and fixed-effect models were used for the meta-analysis of pooled mean differences (MDs) and odds ratios (ORs). The Mantel–Haenszel method was adopted.

Results

A total of 1008 patients were identified, of whom 689 and 319 underwent TKA for valgus knee deformity with lateral and medial approach, respectively. The mean age was 70 ± 9.5 and 67.3 ± 9.6 years for the lateral and medial approaches, respectively. The mean follow-up was 37.8 ± 21.9 and 45.9 ± 26.7 months for the lateral and medial approach groups, respectively. Significantly higher functional outcomes were found for the medial approach, as measured by the postoperative KSS (MD = 1.8, 95% CI [0.48, 3.12], P = 0.007) and flexion ROM (MD = 3.12, 95% CI [0.45, 5.79], P = 0.02). However, both of these differences were lower than the minimal clinically important difference. Comparable surgical time and postoperative HKA angle values (MD = 0.22, 95% CI [− 0.30, 0.75], P = 0.40) between the two surgical approaches were found. The incidence of periprosthetic joint infections, fractures, transient peroneal nerve injuries, and deep vein thrombosis was comparable.

Conclusion

This meta-analysis of comparative studies showed that when lateral and medial approaches are used for total knee arthroplasty for valgus knee deformity, comparable functional outcomes in terms of the KSS and ROM, surgical time, and postoperative hip–knee–ankle angle values can be expected. Similar rates of periprosthetic joint infection, fracture, and peroneal nerve injury were also found.

Level of evidence

PROSPERO registration number ID

CRD42023392807.

Available only for authorised users

Apostolopoulos AP, Nikolopoulos DD, Polyzois I et al (2010) Total knee arthroplasty in severe valgus deformity: Interest of combining a lateral approach with a tibial tubercle osteotomy. Orthop Traumatol Surg Res 96:777–784. https://doi.org/10.1016/j.otsr.2010.06.008CrossRefPubMed

Ranawat AS, Ranawat CS, Elkus M et al (2005) Total knee arthroplasty for severe valgus deformity. JBJS 87:14

Tan MWP, Ng SWL, Chen JY et al (2021) Long-term functional outcomes and quality of life at minimum 10-year follow-up after fixed-bearing unicompartmental knee arthroplasty and total knee arthroplasty for isolated medial compartment osteoarthritis. J Arthroplasty 36:1269–1276. https://doi.org/10.1016/j.arth.2020.10.049CrossRefPubMed

Alesi D, Meena A, Fratini S et al (2022) Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg 106:1–8. https://doi.org/10.1007/s12306-021-00695-xCrossRefPubMed

Schiapparelli F-F, Amsler F, Hirschmann MT (2018) Medial parapatellar approach leads to internal rotation of tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:1564–1570. https://doi.org/10.1007/s00167-017-4586-7CrossRefPubMed

Karachalios T, Sarangi PP, Hewman JH (1994) Severe varus and valgus deformities treated by total knee arthroplasty. J Bone Jt Surg 76:938–942CrossRef

Keblish P (1991) The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop 271:52–62CrossRef

Higgins JPT, Altman DG, Gotzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928–d5928. https://doi.org/10.1136/bmj.d5928CrossRefPubMedPubMedCentral

Greenberg A, Kandel L, Liebergall M, Mattan Y, Rivkin G (2020) Total knee arthroplasty for valgus deformity via a lateral approach: clinical results, comparison to medial approach, and review of recent literature. J Arthroplast 35:2076–2083CrossRef

10.

Kornilov N, Kulyaba T, PetuKhov A et al (2015) Computer navigation helps achieving appropriate gap balancing and restoration of alignment in total knee arthroplasty for fixed valgus knee osteoarthritis irrespective of the surgical approach. Acta Orthop 81:673–681

11.

Gunst S, Villa V, Magnussen R et al (2016) Equivalent results of medial and lateral parapatellar approach for total knee arthroplasty in mild valgus deformities. Int Orthop 40:945–951. https://doi.org/10.1007/s00264-015-2893-5CrossRefPubMed

12.

Niki Y, Matsumoto H, Hakozaki A et al (2011) Clinical and radiographic outcomes of minimally invasive total knee arthroplasty through a lateral approach. Knee Surg Sports Traumatol Arthrosc 19:973–979. https://doi.org/10.1007/s00167-010-1323-xCrossRefPubMed

13.

Sekiya H, Takatoku K, Takada H et al (2014) Lateral approach is advantageous in total knee arthroplasty for valgus deformed knee. Eur J Orthop Surg Traumatol 24:111–115. https://doi.org/10.1007/s00590-012-1137-2CrossRefPubMed

14.

Nikolopoulos DD, Polyzois I, Apostolopoulos AP et al (2011) Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy. Knee Surg Sports Traumatol Arthrosc 19:1834–1842. https://doi.org/10.1007/s00167-011-1474-4CrossRefPubMed

15.

Tonelli Filho JR, Passarelli MC, Brito JAS et al (2016) Keblish’s lateral surgical approach enhances patellar tilt in valgus knee arthroplasty. Rev Bras Ortop Engl Ed 51:680–686. https://doi.org/10.1016/j.rboe.2016.10.010CrossRef

16.

Dudek P, Marczak D, Okoń T et al (2022) Lateral or medial parapatellar surgical approach to the valgus osteoarthritic knee? A retrospective single-center study. J Clin Med 11:5953. https://doi.org/10.3390/jcm11195953CrossRefPubMedPubMedCentral

17.

Guo C-J, Liu J, Niu D-S et al (2018) Clinical application of different operative approach of total knee replacement in knee valgus patients. Retrospective cohort study. Int J Surg 49:80–83. https://doi.org/10.1016/j.ijsu.2017.12.008CrossRefPubMed

18.

Rawal J, Devany AJ, Jeffery JA (2015) Arthroplasty in the valgus knee: comparison and discussion of lateral vs medial parapatellar approaches and implant selection. Open Orthop J 9:94–97. https://doi.org/10.2174/1874325001509010094CrossRefPubMedPubMedCentral

19.

Wang B, Xing D, Li JJ et al (2019) Lateral or medial approach for valgus knee in total knee arthroplasty—which one is better? A systematic review. J Int Med Res 47:5400–5413. https://doi.org/10.1177/0300060519882208CrossRefPubMedPubMedCentral

20.

Xu G, Fu X, Tian P et al (2020) The lateral and medial approach in total arthroplasty for valgus knee: a meta-analysis of current literature. J Comp Eff Res 9:35–44. https://doi.org/10.2217/cer-2019-0111CrossRefPubMed

21.

Langen S, Gaber S, Zdravkovic V et al (2016) Lateral subvastus approach with tibial tubercle osteotomy for primary total knee arthroplasty: clinical outcome and complications compared to medial parapatellar approach. Eur J Orthop Surg Traumatol 26:215–222. https://doi.org/10.1007/s00590-015-1718-yCrossRefPubMed

22.

Lizaur-Utrilla A, Gonzalez-Parreño S, Martinez-Mendez D et al (2020) Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surg Sports Traumatol Arthrosc 28:1473–1478. https://doi.org/10.1007/s00167-019-05543-xCrossRefPubMed

23.

Leopold SS, Porcher R (2017) Editorial: The minimum clinically important difference—the least we can do. Clin Orthop 475:929–932. https://doi.org/10.1007/s11999-017-5253-5CrossRefPubMedPubMedCentral

24.

Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH (2017) Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev 6:245. https://doi.org/10.1186/s13643-017-0644-yCrossRefPubMedPubMedCentral

Title: Lateral versus medial approach for total knee arthroplasty for valgus knee deformity shows comparable functional outcomes, hip–knee–ankle angle values, and complication rates: a meta-analysis of comparative studies
Authors: Michele Mercurio
Giorgio Gasparini
Olimpio Galasso
Filippo Familiari
Erminia Cofano
Valentina Sanzo
Gianluca Ciolli
Katia Corona
Simone Cerciello
Publication date: 21-10-2023
Publisher: Springer Berlin Heidelberg
Keyword: Joint Infection
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05088-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lateral versus medial approach for total knee arthroplasty for valgus knee deformity shows comparable functional outcomes, hip–knee–ankle angle values, and complication rates: a meta-analysis of comparative studies

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

PROSPERO registration number ID

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Level of evidence

PROSPERO registration number ID

Please log in to get access to this content

Other articles of this Issue 2/2024

Mid-term clinical and sonographic outcomes of minimally invasive acromioclavicular joint reconstruction: mini-open versus arthroscopically assisted

Midterm results of modular hinge total knee arthroplasty using cementless osseointegrating stems: low fixation associated complications and good functional outcome in primary and revision knee arthroplasty

The increased lateral tibial slope may result in inferior long-term clinical outcome after DB-ACL reconstruction

The impact of retaining the femoral stem in revision total hip arthroplasty: a systematic review, meta-analysis, and meta-regression

Blocking screw (pin) technique to achieve an acceptable reduction in intramedullary of subtrochanteric femoral fractures: indications, techniques, and clinical outcomes

Cortical bone thickness on preoperative CT scans as predictor of bone quality in distal femur fractures: a retrospective study in Caucasians