Mid-Term Follow Up Results of Mini-Subvastus Approach for Total Knee Arthroplasty in Obese Patients
DOI:
https://doi.org/10.15438/rr.7.3.174Keywords:
Mini-subvastus approach, Total knee arthroplasty, ObesityAbstract
Background: Use of mini-subvastus approach for total knee arthroplasty (TKA ) in obese patients is still debated . We had hypothesized in our study published in July 2010 , that obesity should not be considered as a problem for patients undergoing a TKA with the mini-subvastus approach as the anatomy of the quadriceps in the obese and the non-obese patient population is the same. We present a mid-term follow-up study of the same set of patients with an average follow up of 96 months.
Materials and Methods: 97 obese patients (109 knees) 81 females + 16 males with mean age 64 years underwent TKA by mini-subvastus approach between January 2006 to July 2007. 16 patients (18 knees) were morbidly obese. Out of the total number of patients, 08 were lost in follow up and 01 died because of unrelated causes. Out of these 09 patients, two were operated for bilateral TKR. Thus, we have a midterm follow up results of 98 knees in 88 patients. Knee society and functional scores were used for patient evaluation and compared to their pre-operative and earlier follow up scores.
Results: At our latest follow-up of 96 months the Knee Society Score and functional scores were 84(range 64-90) and 58(range 45-75) respectively. One morbidly obese lady had aseptic loosening of tibial component at 42 months which needed a revision.
Conclusion: Our mid-term results show that the mini-subvastus approach can be considered for TKA in obese and morbidly obese patient population with outcomes comparable to standard surgical approach.
Keywords: Mini-subvastus approach, Total knee arthroplasty ,Obesity
References
Saif Salih and Paul Sutton. Obesity, knee osteoarthritis and knee arthroplasty: a review. BMC Sports Science, Medicine and Rehabilitation 2013, 5:25
Vasarhelyi EM, MacDonald SJ: The influence of obesity on total joint arthroplasty.
J Bone Joint Surg Br 2012, 94:100-102.
Amin AK, Clayton RA, Patton JT, Gaston M, Cook RE, Brenkel IJ. Total knee replacement in morbidly obese patients. Results of a prospective, matched study. J Bone Joint Surg Br. 2006;88:1321–6. [PubMed]
Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am. 2004;86:1609–15. [PubMed]
Winiarsky R, Barth P, Lotke P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am. 1998;80:1770–4. [PubMed]
Amin AK, Patton JT, Cook RE, Brenkel IJ: Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br 2006, 88:335-340. PubMed Abstract | Publisher Full Text
Matsueda M, Gustilo RB. Subvastus and medial parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res. 2000;371:161–8. [PubMed]
Scuderi GR, Tenholder M, Capeci C. Surgical approaches in mini-incision total knee arthroplasty. Clin Orthop Relat Res. 2004;428:61–7. [doi: 10.1097/01.blo.0000148574.79874.d0]
Boerger TO, Aglietti P, Mondanelli N, Sensi L. Mini-subvastus versus medial parapatellar approach in total knee arthroplasty. Clin Orthop Relat Res. 2005; 440:82–7. [PubMed]
Scuderi RG, Tria J A. 2006, Insall and Scott’s Textbook of Knee Surgery, New York,1634p
Engh GA. Midvastsus approach. In: Scuderi GR, Tria Aj Jr, editors. Surgical Techniques in Total Knee Arthroplasty. New York: Springer-Verlag; 2002. pp. 127–30.
Kim JM, Choi NY, Kim SJ. Large thigh girth is a relative contraindication for the subvastus approach in primary total knee arthroplasty. J Arthroplast. 2007;22:4. [PubMed]
Halder A, Beier A, Neumann W. Mini-subvastus approach for total knee replacement.Oper Orthop Traumatol. 2009 Mar;21(1):14-24. [doi: 10.1007/s00064-009-1602-1]
Ewald FC. The Knee Society total knee arthroplasty roentgenographic valuation and scoring system. Clin Orthop Relat Res. 1989;284:9–12. [PubMed]
Kerkhoffs GMMJ, Servien E, Dunn W, Dahm D, Bramer JAM, Haverkamp D: The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 2012, 94:1839–1844.
Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009 Oct;467(10):2606–2612 [PubMed]
Gioe TJ, Novak C, Sinner P, Ma W, Mehle S. Knee arthroplasty in the young patient: survival in a community registry. Clin Orthop Relat Res. 2007;464:83–87. [PubMed]
Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003;85:259–265. [PubMed]
W-Dahl A, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in younger patients: a SwedishRegister Study. Acta Orthop. 2010;81:161–164 [PubMed]
Jones CA, Cox V, Jhangri GS, Suarez-Almazor ME: Delineating the impact of obesity and its relationship on recovery after total joint arthroplasties. Osteoarthr Cartil OARS Osteoarthr Res Soc 2012, 20:511–518.
Collins RA, Walmsley PJ, Amin AK, Brenkel IJ, Clayton RAE: Does obesity influence clinical outcome at nine years following total knee replacement? J Bone Joint Surg Br 2012, 94:1351–1355.
Chalidis BE1, Petsatodis G, Christodoulou AG, Christoforidis J, Papadopoulos PP, Pournaras J. Is obesity a contraindication for minimal invasive total knee replacement? A prospective randomized control trial. Obes Surg. 2010 Dec;20(12):1633-41. Epub 2009 Sep 16. [PubMed]
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Copyright (c) 2017 Aditya laxmikant Kekatpure, Nilen A Shah, Prithviraj Prabhakar Nistane, Pritam K Agrawal
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