A Modified Surgical Approach in Total Knee Arthroplasty – Reproducible in Primary and Revision Arthroplasty - Transtendinous of the Extensor Mechanism

Abstract We have tried to reduce complications in TKA in three directions. 1. The patelloplasty complications using the modified approach. 2. In cases of severe deformity, a tibial stem extension is added to distribute the forces and improve the stability of the implants. 3. To reduce the number of devastating septic failures. Since 2017, we modified the traditional medial approach in TKA. We have used this modified method on 706 TKA patients, including 302 females and 281 males. We compared the results with other studies regarding the patellar complications in total knee arthroplasty. The difference between the two surgical methods essentially concerns the patellar complications in TKA. Patients using the medial modified approach have not experienced any avascular necrosis, stress fractures, or patellar dislocation or subluxation. Eighty of those 706 TKA cases had severe deformities, such as large preexisting defects, osteoporotic bone structure, or severe varus-valgus deviation. The same type of implants was used with or without tibial stem extension. Our septic incidence was 1.27%, which was less than the 2.7% reported in other countries. Using the same soft tissue approach, the procedure facilitates the surgery in certain sepsis circumstances. This modified approach is reproducible, gives a large exposure and allows even the revisions through the same approach. It is useful even in severe knee deformity, allowing tibial stem extension. The recovery is good due to the tendinous healing. Keywords: Modified approach transtendinous of the extensor mechanism; Total Knee Arthroplasty TKA; Tibial stem extension; Functional alignment FA