Comparison of the Vastus-Splitting and Median Parapatellar Approaches for Primary Total Knee Arthroplasty: A Prospective, Randomized Study by Matthew J.

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Presentation transcript:

Comparison of the Vastus-Splitting and Median Parapatellar Approaches for Primary Total Knee Arthroplasty: A Prospective, Randomized Study by Matthew J. Kelly, Mustasim N. Rumi, Milind Kothari, Michael A. Parentis, Katrina J. Bailey, William M. Parrish, and Vincent D. Pellegrini J Bone Joint Surg Am Volume 89(2 suppl 1):80-92 March 1, 2007 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Preoperative anteroposterior and lateral radiographs of the knee and a Merchant radiograph of the patella. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

A split leg operating table with the leg rest for the involved limb removed at the popliteal crease is used for total knee arthroplasty. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Dissection of the subcutaneous flap including the superficial retinaculum (asterisks). Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The incision extends into the vastus medialis fascia (arrows) medial to the quadriceps tendon and continuous with the superficial fascia (asterisk). Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Elevation of the superficial vastus medialis fascia (asterisk) and opening the compartment exposing the muscle fibers of the vastus medialis. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

A clamp is used to initiate the vastus medialis split at the superomedial corner of the patella. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Army-Navy retractors are then placed into the split, exposing fat (asterisk) beneath the deep fascia of the vastus medialis. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The vastus split is developed proximally in a blunt fashion digitally until a neurovascular bundle is encountered or until the medial aspect of the compartment is reached. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

A medial capsular soft-tissue sleeve is elevated from the medial aspect of the tibial tubercle to the midcoronal plane. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Two Hohmann retractors complete exposure of the proximal tibial surface of the right knee. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

After tourniquet release, the proximal extent of the vastus medialis split (asterisk) is inspected for bleeding. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.

The fascial compartment of the vastus medialis is closed by reapproximation of the superficial fascia (asterisks) to the medial border of the quadriceps tendon along with the superficial retinaculum and the subcutaneous tissues in a single layer. Matthew J. Kelly et al. J Bone Joint Surg Am 2007;89:80-92 ©2007 by The Journal of Bone and Joint Surgery, Inc.