A Modified Lateral Approach for Total Knee Replacement in Type 2 Valgus Deformity

Total knee replacement for patients with osteoarthritis and valgus deformity remains challenging, with soft tissue balance often difficult to achieve. Most orthopedic surgeons use the medial parapatellar approach for total knee replacement. However, the lateral approach described in this case allows direct access to the pathology. The valgus deformity is corrected by using a modified lateral parapatellar arthrotomy with a staged and gradual release of the contracted lateral capsuloligamentous structures and the iliotibial tract. A Z-shaped dissection of the lateral retinaculum and careful dissection and preservation of the infrapatellar fat pad is performed. The creation of this laterally based vascularized flap provides the necessary tissue to cover the soft tissue gap resulting on the lateral aspect of the knee after valgus correction. The lateral approach has advantages, including ligament balancing and preservation of the medial retinaculum and the medial neurovascular structures for the supply of the patella. However, this approach should be used with caution by experienced surgeons. [Orthopedics. 2017; 40(5):313-316.].