A lateral approach defect closure technique with deep fascia flap for valgus knee TKA

Jun Jiang, Julio C Fernandes

Routinely, we use a midline skin incision and lateral parapatellar approach of the knee to perform valgus knee TKA (total knee arthroplasty). It is generally very difficult to close the lateral capsular defect after valgus knee TKA, especially for severe valgus and flexion knee deformity. We describe a new surgical technique to close the lateral capsular defect with a deep fascia flap. From 2009 to 2012, we used the new technique to close lateral capsular defects for nine valgus TKA in eight patients. The wound healing, infection, range of motion, and postoperative X-ray Laurien view were evaluated. According to follow-up, we found that this technique can reduce the risk of intra- and postoperative complications (exposure of knee prosthesis, larger subcutaneous hematoma, poor wound healing, and higher risk of infection) and improve clinical outcome of total knee replacement (good range of motion and patellar tracking). There is no need for lateral parapatellar capsule Z-plasty during incision or filling the distal capsular defect with fat pad or composite meniscal-capsular-fat pad. Closing lateral capsular defect with a deep fascia flap for valgus knee TKA through a lateral parapatellar approach is a new and effective surgical technique.