RESUMO
This study presents a modification of the medial parapatellar surgical approach for total knee arthroplasty. This approach separates the vastus medialis muscle in the direction of its fibers beginning at the superior pole of the patella. One hundred eighteen consecutive total knee arthroplasty cases, performed by a single surgeon, were randomized prospectively to receive a medial parapatellar or midvastus muscle-splitting surgical approach. The frequency of lateral retinacular releases was recorded, patellar tilt and translation were measured, and quadriceps strength was tested. The midvastus muscle-splitting approach provided excellent exposure to all knees. Patellar stability and quadriceps strength were equivalent for the two approaches. It is concluded that the midvastus muscle-splitting approach is an efficacious alternative to the medial parapatellar approach for primary total knee arthroplasties.
Assuntos
Prótese do Joelho/métodos , Músculo Esquelético/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Coxa da Perna , Resultado do TratamentoRESUMO
One hundred thirty-six primary total knee arthroplasty patients were randomized for the use of closed-suction, nonreinfusable wound drains. Blood loss was identical in the drained and undrained groups. Forty percent of undrained wounds compared with 0% of drained wounds required dressing reinforcement. Sixty-nine percent of undrained wounds compared with 39% of drained wounds developed ecchymosis, measuring 92 cm2 in the undrained group and 28 cm2 in the drained group. This study concludes that a simple wound drain effectively minimizes the undesirable accumulation of blood in the surrounding soft tissues and the postoperative wound dressing after total knee arthroplasty.
Assuntos
Artroplastia do Joelho/métodos , Sucção/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Bandagens , Transfusão de Sangue , Drenagem , Equimose/etiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Incidência , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Estudos Prospectivos , Amplitude de Movimento Articular , Cicatrização/fisiologiaRESUMO
The proximity of the vascular structures traversing the adductor hiatus in the medial distal femur is a potential concern for the surgeon. The distance from the adductor tubercle to the adductor hiatus was measured in both lower extremities in 24 skeletally mature cadavers. This distance ranged from 8.0 to 13.5 cm (mean 10.0). The area up to 8 cm proximal to the adductor tubercle, anterior to the medial intermuscular septum, appears to be a safe interval for avoiding vascular structures with percutaneous or limited open surgeries of the medial aspect of the distal femur.