Total Knee Arthroplasty via Small-­Incision Midvastus Approach

Total Knee Arthroplasty via Small-­Incision Midvastus Approach

Introduction

Patient Selection

Indications

  • Same as those for standard TKA—Disability from knee arthritis, refractory to nonsurgical measures
  • Should first try course of activity modification, anti-­inflammatory medication, physical therapy, and weight reduction

Contraindications

TABLE 1

Relative Contraindications to the Small-­Incision Midvastus Approach

Substantial quadriceps muscle mass in men
Significant obesity (body mass index >40 kg/m2)
Severe coronal plane deformity
Flexion contracture >25°
Passive flexion <80°
Severe patella baja
Significant scarring of the quadriceps mechanism
Revision surgery

Preoperative Imaging

  • Standing AP, lateral, 45° flexed PA, Merchant view radiographs
  • Interpret radiographs for deformity, bone loss, presence of patella baja, and bone quality
  • For deformity, useful to anticipate appropriate distal femoral cut angle and height of tibial resection

Procedure

Patient Positioning

image
Figure 1Photograph shows a patient positioned on the operating table with a bump placed across from the opposite ankle to hold the leg at 70° to 90°.

Special Instruments

Surgical Technique

Video 63.1 Mini-­Midvastus Approach. Steven B. Haas, MD, MPH; Stephen Kim, MD (16 min)

Anesthesia

  • Authors prefer combined spinal/epidural anesthetic with indwelling epidural patient-­controlled anesthesia for 48 hours
  • Bupivacaine femoral nerve block
  • Intravenous cefazolin; vancomycin for penicillin allergy

Exposure

May 13, 2023 | Posted by in Uncategorized | Comments Off on Total Knee Arthroplasty via Small-­Incision Midvastus Approach

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