Fast-track total diz artroplastisinde medial parapatellar, mini-midvastus ve subvastus cerrahi yaklaşımlarının kısa dönem radyografik sonuçlarının karşılaştırılması

Öz

Amaç: Diz eklemine erişimdeki zorluklar nedeniyle, total diz artroplastisi (TDA) uygulaması sırasında doğru protez yerleşimi büyük önem taşımaktadır. Bu çalışmanın amacı medial parapatellar (MPP), mini-midvastus (mMV) veya subvastus (SV) cerrahi yaklaşımları ile fast-track TDA uygulanan hastalarda kısa dönem radyografik X-ray sonuçlarını karşılaştırmaktır. Gereç ve yöntem: 2018-2020 yılları arasında MPP, mMV ve SV cerrahi yaklaşımlarıyla opere edilen ve cerrahi öncesi ve cerrahi sonrası altıncı hafta radyografik sonuçları eksiksiz olan 93 hastanın verisi retrospektif olarak analiz edildi ve hastalar üç gruba ayrıldı: MPP (n=31), mMV (n=31) ve SV (n=31). Cerrahi yaklaşımların cerrahi öncesi ve cerrahi sonrası altıncı hafta X-ray görüntülerine ait dizilimleri ölçüldü. MPP, mMV ve SV cerrahi yaklaşımlarıyla uygulanan fast-track TDA’nın operasyon süresi kaydedildi. Bulgular: MPP grubu, cerrahi öncesinde mMV grubuna göre daha yüksek lateral distal femoral açıya ve SV grubuna göre daha yüksek lateral proksimal femoral açıya sahipti (sırasıyla p=0,018 ve p=0,027). mMV grubunun cerrahi sonrası proksimal medial tibial açısı SV grubuna göre daha yüksekti (p=0,011). Cerrahi sonrası altıncı haftada, MPP ve mMV grupları SV grubuna göre daha düşük posterior tibial eğim açısına sahipti (p=0,001). MPP yaklaşımı, mMV ve SV yaklaşımlarına göre anlamlı derecede daha kısa operasyon süresine sahipti (p=0,001). Sonuç: Sonuçlar, MPP, mMV ve SV cerrahi yaklaşımlarının fast-track TDA sırasında memnun edici bir protez dizilimi elde etmede tercih edilebilir ve uygulanabilir olduğuna işaret etmektedir. MPP yaklaşımı daha kısa operasyon süresi ve cerrahi komplikasyon risklerini en aza indirmedeki potansiyel avantajı nedeniyle tercih edilebilir.

Anahtar Kelimeler

• Total diz artroplastisi
• cerrahi yaklaşımlar
• radyografi
• operasyon süresi

Comparison of short-term radiographic outcomes of medial parapatellar, mini-midvastus, and subvastus surgical approaches in fast-track total knee arthroplasty

Abstract

Purpose: Due to the difficulties in accessing the knee joint, correct prosthesis placement is of great importance during the implementation of total knee arthroplasty (TKA). This study aimed to compare short-term radiographic X-ray outcomes in patients who underwent fast-track TKA with medial parapatellar (MPP), mini-midvastus (mMV), or subvastus (SV) surgical approaches. Materials and methods: Between 2018 and 2020, 93 patients operated with MPP, mMV, and SV surgical approaches and who had complete data of radiographic outcomes before and sixth-week postoperative were retrospectively analyzed and patients divided into three groups: MPP (n=31), mMV (n=31), and SV (n=31). The alignments of preoperative and sixth-week postoperative X-ray images of the surgical approaches were measured. The operative time of fast-track TKA implementation with MPP, mMV, and SV surgical approaches was recorded. Results: The MPP group had a higher preoperative lateral distal femoral angle than the mMV group and a higher preoperative lateral proximal femoral angle than the SV group (p=0.018 and p=0.027, respectively). The mMV group had a higher postoperative proximal medial tibial angle than the SV group (p=0.011). In the postoperative sixth week, the MPP and mMV groups had a lower posterior tibial slope angle than the SV group (p=0.001). The MPP approach had significantly shorter operative time than the mMV and SV approaches (p=0.001). Conclusion: The outcomes indicate that MPP, mMV, and SV surgical approaches are preferable and feasible in obtaining a satisfactory prosthesis alignment during fast-track TKA. The MPP approach may be preferable because of its shorter operative time and potential advantage in minimizing surgical complication risks.

Keywords

• Total knee replacement
• surgical approaches
• radiography
• operative time

Kaynakça

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