RESUMO
INTRODUCTION: The lateral parapatellar approach provides direct access to the pathological area in a valgus knee deformity and allows sequential titrated release of contracted lateral soft tissues during total knee arthroplasty. STEP 1 PREOPERATIVE PLANNING: Differentiate the flexible and fixed components of the valgus deformity by clinical and radiographic examination. STEP 2 EXPANSILE LATERAL ARTHROTOMY: Open the knee joint from the lateral side by coronal z-plasty of the lateral retinaculum, oblique lateral tenotomy of the quadriceps tendon, and iliotibial band release. STEP 3 QUADRICEPS SNIP AND JOINT EXPOSURE: Perform a quadriceps snip and expose the knee joint. STEP 4 TIBIAL AND DISTAL FEMORAL CUTS: Make proximal tibial and distal femoral cuts in appropriate alignment. STEP 5 EXTENSION GAP BALANCING: A rectangular extension gap is the goal. STEP 6 FLEXION GAP BALANCING: Determine the femoral component size and femoral rotation, and balance the flexion gap. STEP 7 COMPONENT FIXATION: Confirm tibial rotational alignment, fix the components, and assess patellar tracking. STEP 8 PROSTHETIC JOINT CLOSURE: Perform closure of the prosthetic joint with expanded lateral structures. RESULTS: Between 2003 and 2009, thirty-two knees with clinical valgus deformity of >10° underwent total knee arthroplasty with an expansile lateral arthrotomy technique11.IndicationsContraindicationsPitfalls & Challenges.
