Abstract
Aims: Correction of fixed valgus is a challenge in primary TKA. The direct lateral approach, with/without tubercle osteotomy, is an approach option utilized in two reporting centers. Methods: 255 valgus TKA with 5- to15- year follow-up were reviewed. Demographics included 91% females, 15% rheumatoid, mean age 69. Prostheses utilized were LCS mobile-bearing (meniscal PCL-retaining/rotating PCL-sacrificing). Patella was non-resurfaced in 90%; cementless fixation in 86%. Results: Good/excellent 91%, modified HSS score improvement 57 to 85. Deformity (12) improved < 8 to 12 points (> 15° valgus to < 5° valgus). ROM improved from mean 11°/97° to 1/110° latest. Technical/prosthetic-related complications included: 7 bearing failures (5 meniscal, 2 rotating platform), 2 aseptic loosenings (tibial), 1 patella ligament rupture and 2 screw loosenings in the osteotomy group, 1 patella re-dislocation in a 75-year-old female with dislocation since age 15 (non-osteotomy group), 2 infections, and 1 re-operation for arthrofibrosis. Conclusion: Valgus TKA using LCS moveable bearings implanted via a direct lateral approach are highly successful regarding stability and patella tracking. Failures correlate with inadequate/de-stabilizing releases and meniscal PCL-retaining prostheses. Rotating bearings allow for better stability and self-adjustment of common mal-rotation variables. The lateral approach allows for direct (stepwise) lengthening releases, improved patellar tracking, and precise gap balancing.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
