Total Knee Replacement in Lateral Arthritis Specifics and Surgical Techniques
A lateral paramedian skin incision is made. Proximally the quadriceps tendon is identified and distally the lateral border of the patellar tendon exposed. The arthrotomy is made with a longitudinal incision of the quadriceps tendon on its lateral side leaving a small cuff of tendinous tissue attached to the vastus lateralis muscle allowing later closure. The patella is dislocated and the arthrotomy is continued distally, lateral to the patellar tendon onto the anterolateral tibial plateau. When dissecting at the level of the patellar tendon, we prefer to bring a portion of the fat pad laterally with the retinaculum. This maneuver results in additional soft tissue for use during closures and can be quite useful in cases in which a significant valgus deformity is corrected with the TKA. The lateral capsule is released close to the bone on the anterolateral border of tibial plateau. The capsule remains in continuity with the tendinous origin of the tibialis anterior muscle. The insertion of the ITB is released subperiosteally from Gerdy’s tubercle with the scalpel. Because of the continuity of the ITB proximally with the tibialis anterior muscle distally, we prefer this digastric dissection (Fig. 25.1).