Lateral approach without ligament release in total knee arthroplasty: new concepts in the surgical technique

A lateral approach without ligament release was performed in 475 primary total knee arthroplasties (TKAs) in 344 patients and 50 revision TKAs in 39 patients. Deformities of the genu varum or valgum were corrected by accurate bone cut; no ligament releases were required other than to achieve adequate exposure. A lateral approach allowed both self-centering of the extensor mechanism and knee closure in complete flexion. Better range of motion was achieved. More than 90 degree active flexion usually occurred 3 days postoperatively. Postoperative roentgenograms showed all knees had good varus and valgus stability, which was sustained with time, except 1 with late genu recurvatum due to inadequate polyethylene thickness and the other with a broken tibial base plate. Complications such as disruption of patellar blood supply and knee instability, more frequently observed in the medial approach with ligament release, did not occur. The results suggest that this new technique is safe and may give better outcomes.