New concepts in medial release based on experience with varus Tka’s

12^th International Conference on Arthroplasty

June 24-25, 2019 | Rome, Italy

Rashid Ganji

Sina Hospital, Iran

Posters & Accepted Abstracts: J.Orthop.Trauma Surg.Relat.Res.

Abstract :

Background: Patients with severe Varus knees is common in developing countries (i.e. Middle East) where Total Knee Arthroplasty (TKA) can effectively resolve this issue. There are many methods to perform this medial release. However, each technique may have implied disadvantages. For this reason, many surgeons are unable to avoid instability and stop using semi-constrained prosthesis in this group of patients indeterminately. We have developed a new concept for this release based on our experience in performing over 5000 surgical cases to decrease subtle instability and reach nearly 0% use of semi-constrained prosthesis.

Methods: Surgical procedures were accomplished by the same surgeon with measured resection technique, and cemented posterior-stabilized prosthesis. 250 TKAs were in this study and divided them into 3 groups. First group of patients had varus deformity up to 15 degrees, second group 15-25 degrees, and the third group over 25 degrees. The medial soft tissue release was distinctive for each group by only releasing the deep MCL and capsule for the first group. We evaluated our outcome based on the Knee Society Score at 2 and 6 months, and 1 year postoperatively.

Results: Results showed that in mild deformity, there was no need for considerable release. Even in moderate deformity with little extension release to the posteromedial corner, we can obtain good balancing. For severe deformity, the main objective was to retain the superficial MCL as much as possible even by accepting some lateral widening of the joint. No patient developed postoperative medial instability.

Conclusion: This approach, considering sex, body mass index, and different soft tissue quality, as one of the alternatives in soft tissue balancing resulted in nearly 0% use of semi-constrained prosthesis and even avoidance of subtle instability in severe varus deformity cases (+25 degrees).