Sina Hospital, Iran
Title: New Concepts In Medial Release Based On Experience With Varus Total Knee Arthroplasty
Dr. Ganji is that he specializes and focuses solely on total knee replacements. By using up-to-date and proven techniques, he is a leader in the field. He has been specialized in the field since 1997 and completed his residency in Mashhad (2nd largest city in Iran). He is certified by the Iran Orthopedic Surgery Organization. Furthermore, he has continued his education and has earned various certifications in USA, Germany, Italy, and Belgium.Dr. Ganji is currently associated with The Iranian Orthopedic Society, The Iranian Society of Knee Surgery as well as America Association of Hip and Knee Surgeons. His areas of research include long-term follow-up studies associated with total knee replacement, especially in severe deformities and revisions.He is commonly invited to give lectures world-wide on total knee replacements & various special cases, Dr. Ganji is considered as an expert in the field Orthopedics, specifically total knee replacement, by his respected peers.
Background: Patients with severe Varus knees is common in developing countries (i.e. Middle East) where Total Knee Arthroplasty (TKA) can effectively resolve this issue. There are many methods to perform this medial release. However, each technique may have implied disadvantages. For this reason, many surgeons are unable to avoid instability and stop using semi-constrained prosthesis in this group of patients indeterminately. We have developed a new concept for this release based on our experience in performing over 5000 surgical cases to decrease subtle instability and reach nearly 0% use of semi-constrained prosthesis.
Methods: Surgical procedures were accomplished by the same surgeon with measured resection technique, and cemented posterior-stabilized prosthesis. 250 TKAs were in this study and divided them into 3 groups. First group of patients had varus deformity up to 15 degrees, second group 15-25 degrees, and the third group over 25 degrees. The medial soft tissue release was distinctive for each group by only releasing the deep MCL and capsule for the first group. We evaluated our outcome based on the Knee Society Score at 2 and 6 months, and 1 year postoperatively.
Results: Results showed that in mild deformity, there was no need for considerable release. Even in moderate deformity with little extension release to the posteromedial corner, we can obtain good balancing. For severe deformity, the main objective was to retain the superficial MCL as much as possible even by accepting some lateral widening of the joint. No patient developed postoperative medial instability.
Conclusion: This approach, considering sex, body mass index, and different soft tissue quality, as one of the alternatives in soft tissue balancing resulted in nearly 0% use of semi-constrained prosthesis and even avoidance of subtle instability in severe varus deformity cases (+25 degrees).