Complications following quadriceps-sparing total knee arthroplasty

This study examined whether quadriceps-sparing total knee arthroplasty (TKA) through a minimal medial incision could be performed without an increased risk of complications. Data were collected prospectively on 209 patients who underwent quadriceps-sparing TKA though a median parapatellar approach. Surgical complications included 2 patellar tendon avulsions, 2 lateral collateral ligament ruptures, and 1 medal collateral ligament rupture. Arthrofibrosis occurred in 21 patients (10%) requiring manipulation under anesthesia, and minor wound complications occurred in 22 patients (11%). Unintended cement retention was noted on 16 radiographs (8%). At 6 months of follow-up, Knee Society scores and functional outcomes were unchanged from previous experience with standard TKA. Compared to previous experience with traditional medial parapatellar approaches, the rate of intraoperative complications such as ligament rupture and retention of cement were higher than expected. Complication rates in the second 100 patients who underwent quadriceps-sparing TKA showed no significant difference compared to previous patients who underwent standard TKA. Complications were more common in patients with preoperative peripheral vascular disease, body mass index >33, and valgus deformity >10 degrees ; these patients may not be good candidates for this modified procedure. This quadriceps-sparing technique required a progressive learning curve and has not yet proven to be superior to standard approaches. However, complication rates after extensive experience were not significantly increased.