The mini-midvastus approach for total knee arthroplasty

Surgical technique for primary and revision total knee arthroplasty to reconstruct bone defects with metal augments and reproducible positioning of the implant at the right joint line. Primary and revision total knee arthroplasty with bone defects. Complete destruction of the metaphysis. Implantation of revision components performed in three consecutive steps: first, positioning of the tibia component at correct height and rotation; second, determination of the posterior joint line in flexion through the size and correct rotation of the femoral implant; third, determination of the distal joint line by use of positioning of the femoral component. These steps are performed independently from bone defects, which are subsequently reconstructed with metal augments. Mobilization with weight bearing and range of motion as tolerated, depending on osseous and soft tissue condition at primary or revision surgery. In a prospective study, 132 consecutive knee revisions in 76 women and 56 men with an average age of 72.4 years (range 49-93 years) were followed up clinically and radiologically preoperatively and at a mean follow-up of 74 months (range 38-105 months). Clinical results were based on the American Knee Society score. The score was 46.3 (range 31-65) preoperatively and 82.5 (range 61-96) at follow-up. Radiologically 12.1 % of the knees showed lysis around the augment with no clinical signs of loosening. No revisions were performed due to aseptic loosening. The joint line was correctly reconstructed in 84.8 %.