Total diz artroplastisinde minimal invazif midvastus ve standart medial parapatellar yaklaşımların karşılaştırması

Yıl 2013, Cilt: 47 Sayı: 1, 1 - 7, 05.04.2013

Cem Avcı Deniz Gulabi Mehmet Erdem Recep Kurnaz Taner Gunes Bora Bostan

Öz

Amaç: Çalışmada minimal invazif midvastus insizyon (MMV) tekniği ve standart medial parapatellar teknikle (ST) yapılan total diz protezlerinin (TDP) kısa dönem sonuçlarının karşılaştırılması amaçlandı.
Çalışma planı: Çalışmada TDP ameliyatı ST ile yapılan 20 hasta (18 erkek, 2 kadın; ort. yaş 67.25± 6.7) ile MMV yöntemle yapılan 19 hasta (4 erkek, 15 kadın; ort. yaş 64.53±7.53) geriye dönük olarak değerlendirildi. İki grup ameliyat süresi, kan kaybı, ameliyat sonrası düz bacak kaldırmaya başlama zamanı (DBK), eklem hareket açıklığı ve Knee Society (KSS) ve Hospital for Special Surgery (HSS) skorları yönünden karşılaştırıldı. Radyolojik olarak ise ameliyat öncesi ve sonrası ayakta çekilen boy filmleriyle değerlendirme yapıldı. Ortalama takip süresi ST grupta 29.4±8.2 ay, MMV grupta ise 17.7±11.1 aydı.
Bulgular: Ameliyat sonrası erken dönemde (10. gün), eklem hareket açıklığı (EHA) yönünden MMV grubunun ST grubundan anlamlı derecede üstün olduğu gözlendi. DBK zamanı ve kan kaybı yönünden de MMV grubu anlamlı olarak üstündü. Bununla birlikte 6. aydan sonra EHA, KSS ve HSS değerleri açısından iki grup arasında anlamlı fark olmadığı saptandı (p>0.05). Ameliyat süresi MMV grubunda anlamlı olarak, ortalama 22 dakika daha uzundu. Radyolojik olarak ise her iki grupta da ideal dizilimin sağlandığı görüldü. Derin veya yüzeyel enfeksiyon saptanmazken, MMV gruptaki iki hastada klinik takiplerle düzelen cilt problemi gözlendi.
Çıkarımlar: Standart teknikle kıyaslandığında MMV yaklaşımı ile yapılan TDP ameliyatı erken dönemde fonksiyonel olarak daha iyi sonuçlar vermekte, ancak 6. ay sonrasında her iki tekniğin sonuçları da benzer olmaktadır.

Anahtar Kelimeler

Total diz artroplastisi; minimal invazif; midvastus yaklaşımı; medial parapatellar yaklaşım

Minimal invasive midvastus versus standard parapatellar approach in total knee arthroplasty

Öz

Objective: The aim of this study was to compare the short-term results of total knee arthroplasty (TKA) surgeries performed with minimally invasive mini-midvastus (MMV) incision and the standard medial parapatellar technique (ST).
Methods: Twenty patients (18 males, 2 females; mean age: 67.25±6.70) operated with the ST and 19 patients (4 males, 15 females; mean age: 64.53±7.53) operated with the MMV approach were retrospectively evaluated. The surgery time, blood loss, time to straight leg raise (SLR) postoperatively, range of motion (ROM) and Knee Society (KSS) score and Hospital for Special Surgery (HSS) score were compared between the groups. Radiological evaluation was made with standing orthoroentgenographs both pre- and postoperatively. Mean follow-up time was 29.4±8.2 months in the ST and 17.7±11.1 months in the MMV group.
Results: In the early postoperative period (10th day), the MMV group was significantly better than the ST group in terms of ROM. Time to SLR and blood loss values were also significantly better in the MMV group. However, there was no significant difference between the groups after the sixth month, for ROM, KSS and HSS values (p>0.05). Surgery time was significantly longer (with a mean difference of 22 minutes) in the MMV group. Radiological examination revealed ideal alignment in both groups. No deep or superficial infection was detected. Two patients in the MMV group had skin problems which healed after clinical follow-up.
Conclusion: Our results suggested that functional results of TKAs performed via the MMV approach are better in the first six months when compared to those of the ST.

Anahtar Kelimeler

Total knee arthroplasty, minimal invasive, midvastus approach, medial parapatellar approach

Kaynakça

• Keating EM, Meding JB, Faris PM, Ritter MA. Long term follow–up of nonmodular total knee replacements. Clin Orthop Relat Res 2002;(404):34-9.
• Pavone V, Boettner F, Fickert S, Sculco TP. Total condylar knee arthroplasty: a long term followup. Clin Orthop Relat Res 2001;(388):18-25.
• Alfred JT, Thomas MC. Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 2003;(16): 185Tenholder M, Clarke HD, Scuderi GD. Minimal-incision total knee arthroplasty: early clinical experience. Clin Orthop Relat Res 2005;(440):67-76.
• Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC, Pavlov H, Petersen M. Minimally invasive total knee replacement through a mini midvastus incision: an outcome study. Clin Orthop Relat Res 2004;(428):74-81.
• Kolisek FR, Bonutti PM, Hozack WJ, Purtill J, Sharkey PF, Zelicof SB, Ragland PS, Kester M, Mont MA, Rothman RH. Clinical experience using a minimally invasive surgical approach for total knee arthroplasty. J Arthroplasty 2007;22: 8Bullens PH, Van Loon CJ, de Waal Malefijt MC, et al. Patient satisfaction after total knee arthroplasty: a comprasion between subjective and objective outcome assessments. J Arthroplasty 2001;16:740-7.
• Ertürk C, Altay M. A, Sipahio¤lu S, Zehir S, Aflkar H, Early results of total knee arthroplasty performed through the midvastus approach. Acta Orthop Traumatol Turc 2010;44: 36Cila E, Güzel V, Özalay M, Tan J, Simflek SA, Kanatli U, Öztürk A. Subvastus versus medial parapatellar approach in total knee arthroplasty. Acta Orthop Trauma Surg 2002;122: 65Schroer WC, Diesfeld PJ, Reedy ME, LeMarr AR. Isokinetic strength testing of minimally invasive total knee arthroplasty recovery. J Arthroplasty 2010;25:274-9.
• Peter MB, Michael AM, Margo McMahon RN, Phillip SR, Mark K. Minimally invasive total knee arthroplasty. J Bone Joint Surg Am 2004;86;(Suppl 2):26-32.
• Roberts VI, Mereddy PKR, Donnachie NJ, Hakkalamani S. Anatomical variations in vastus medialis obliquus and its implications in minimally invasive total knee replacement: an MRI study. J Bone Joint Sur Br 2007;89-B:1462-5.
• Aglietti P, Baldini A, Sensi L. Quadriceps sparing versus mini-subvastus approach in total knee arthroplasty. Clin Orthop Relat Res 2006;(452):106-11.
• Pagnano MW, Meneghini RM, Trousdale RT. Anatomy of extensor mechanism in reference to quariceps sparing TKA. Clin Orthop Relat Res 2006;(452):102-5.
• Karpman RR, Smith HL. Comparison of the early results of minimally invasive vs standart approaches to total knee arthroplasty: a prospective, randomised study. J Arthroplasty 2009;24:681-8.
• Dalury FD, Mulliken BD, Adams MJ, Lewis C, Sauder RR, Bushey JA. Early recovery after total knee arthroplasty performed with and without patellar eversion and tibial translation: a prospective randomised study. J Bone Joint Surg Am 2009;91:1339-43.
• Wülker N, Lambermont JP, Sacchetti L, Lazaro JG, Nardi J. A prospective randomised study of minimally invasive total knee arthroplasty compared with conventional surgery. J Bone Joint Surg Am 2010;92:1584-90.
• Boerger TO, Aglietti P, Mondanelli N, Sensi L. MiniSubvastus versus medial parapatellar approach in total knee arthroplasty. Clin Orthop Relat Res 2005;(440):82-7.
• Lombardi AV, Viacava AJ, Berend KR. Rapid recovery protocols and minimally invasive surgery help achieve high knee flexion. Clin Orthop Relat Res 2006;(452):117-22.
• King J, Stamper DL, Schaad DC, Leopold SS. Minimally invasive total knee arthroplasty: assesment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am 2007;89:1497-503.
• McAllister CM, Stepanian JD. The impact of minimally invasive surgical techniques on early range of motion after primary total knee arthroplasty. J Arthroplasty 2008;23:10-8. Egocheaga JRV, Suarez MAS, Villan MF, Sastre VG, Gomez JRV, Merchan CR. Minimally invasive subvastus approach: improving the results of total knee arthroplasty: a prospective, randomised trial. Clin Orthop Relat Res 2010;(468):1200-8.
• Haas SB, Cook S, Beksac B. Minimally invasive total knee replacement through a mini midvastus approach: a comperative study. Clin Orthop Relat Res 2004;(428):68-73.
• Laskin RS. Minimally invasive total knee arthroplasty: the results justify its use. Clin Orthop Relat Res 2005;(440):54-9.
• Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamato Y. Minimally invasive versus standart approach in total knee arthroplasty. Clin Orthop Relat Res 2007;(463):144-50.
• Karachalios Th, Giotikas D, Roidis N, Poultsides L, Bargiotas K, Malizos KN. Total knee replacement performed with either a mini-midvastus or a standart approach: a prospective randomised clinical and radiological trial. J Bone Joint Surg Br 2008;90:584-91.
• Han I, Seong SC, Lee S, Yoo JH, Lee MC. Simultaneous bilateral m›s-tka results in faster functional recovery. Clin Orthop Relat Res 2008;466:1449-53.
• Tsuji S, Tomita T, Fujii M, Laskin RS, Yoshikawa H, Sugamoto K. Is minimally invasive surgery-total knee arthroplasty truly less invasive than standart total knee arthroplasty? a quantitative evaluation. J Arthroplasty 2010;25:970-6.
• Cheng T, Liu T, Zhang G, Peng X, Zhang X. Does minimally invasive surgery improve short term recovery in total knee arthroplasty? Clin Orthop Relat Res 2010;468:1635-48.
• Haas SB, Manitta MA, Burdick P. Minimally invasive total knee arthroplasty: the mini midvastus approach. Clin Orthop Relat Res 2006;(452):112-6.
• Nestor MJ, Toulson CE, Backus SI, Lyman SL, Foote KL, Windsor RE. Mini–midvastus vs standart medial parapatellar approach: a prospective, randomised, double–blinded study in patients undergoing bilateral total knee arthroplasty. J Arthroplasty 2010;25(6 Suppl):5-11.
• Chin LP, Foo LSS, Yang KYY, Yeo SJ, Lo NN. Randomized controlled trial comparing the radiologic outcomes of conventional and minimally invasive techniques of total knee arthroplasty. J Arthroplasty 2007;22:800-6.
• Whiteside LA. Mini incision: occasionally desirable,rarely necessary: in the affirmative. J Arthroplasty 2006;21(4 Suppl): 16Cuckler JM. The ugly underbelly of the m›s movement. J Arthroplasty 2007;22(4 Suppl):99-100.
• Dalury DF, Dennis DA: Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 2005;(440):77-81.
• Schroer WC, Diesfeld PJ, Reedy ME, LeMarr AR. Surgical accuracy with the mini–subvastus total knee arthroplasty: a computer tomography scan analysis of postopreative implant alignment. J Arthroplasty 2008;23:543-9.
• Niki Y, Matsumoto H, Otani T, Enomoto H, Toyama Y, Suda Y. Accuracy of implant positioning for minimally invasive total knee arthroplasty in patients with severe varus deformity. J Arthroplasty 2010;25:381-6.
• Yau WP, Leung A, Liu KG, Yan CH, Wong LS, Chiu KY. Errors in identification of the transepicondylar and anteroposterior axes of the distal femur in total knee replacement using minimally-invasive and conventional approaches: a cadaver study . J Bone Joint Surg Br 2008;90:520-6.
• Schroer WC, Diesfeld PJ, Reedy ME, LeMarr AR. Evaluation of complications associated with six hundred mini subvastus total knee arthroplasties. J Bone Joint Surg Am 2007;89:76-81.