Selective medial release using multiple needle puncturing with a spacer block in situ for correcting severe varus deform
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KNEE ARTHROPLASTY
Selective medial release using multiple needle puncturing with a spacer block in situ for correcting severe varus deformity during total knee arthroplasty Han‑Jun Lee1 · Seong Hwan Kim2 · Yong‑Beom Park1 Received: 17 January 2020 / Accepted: 31 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction We aimed to establish a selective and sequential medial release technique using multiple needle puncturing (MNP) with a spacer block in situ in severe varus deformity during total knee arthroplasty (TKA) and to investigate its efficacy and safety. Materials and methods A total of 128 patients with a varus angle >15° were included. Patients were classified according to the tightness of extension and flexion (group 1, no tightness; group 2, extension; group 3, flexion; group 4, extension and flexion). When medial tightness was found on extension, the posterior clearing procedure, including release of the posterior capsule, posterior oblique ligament, and semimembranosus, was performed sequentially. When medial tightness was found on flexion, MNP using an 18-gauge needle with a spacer block in situ was performed at the anterior portion of the superficial MCL (aMCL). Clinical and radiological evaluations including stress radiographs were performed. Results Among 128 knees, 110 required medial release (posterior clearing procedure only in 44 [34.3%], MNP with a spacer block in situ at aMCL only in 38 [29.7%], posterior clearing procedure and MNP in 28 [21.9%]). The mediolateral gap imbalances on extension and/or flexion were significantly improved (p
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