EARLY RESULTS OF LATERAL APPROACH TOTAL KNEE ARTHROPLASTY. Michael Mont; Anil Bhave*; Trisha Griffith; Scott Tennis; Phillip Ragland Physical Therapy, Sinai Hospital Rubin Institute for Advanced Orthopedics, Baltimore, MD UNIQUE: A lateral approach to Total Knee Arthroplasty (TKA) is a new surgical approach that has allowed for improved physical therapy outcomes. This facility is one of the two centers in North America that perform total knee arthroplasty using the lateral approach. Our physical therapy treatment protocol and management of complications for the lateral approach TKA is unique in the field of physical therapy. PURPOSE: We will evaluate physical therapy outcomes following lateral approach TKA. Physical therapy complications that were encountered with this new approach will be explored and we will discuss treatment techniques applied to resolve the issues. FOUNDATION: Typically TKA is performed with a midline incision with some degree of involvement to the extensor mechanism. The midline incision causes increased pain with range of motion (ROM) and there is generally significant decrease in quadriceps strength and function following TKA with this approach. With the lateral approach TKA, the incision is on the lateral aspect of the knee and there is decreased anterior soft tissue restriction and pain with flexion ROM exercises. The extensor mechanism is spared with the lateral approach and improved quadriceps strength and functional outcomes have been reported on our preliminary findings. DESCRIPTION: Our preliminary findings are based on 24 surgeries performed over four months at this facility. Out of the 24 patients, the group consisted of 8 men and 16 women with a mean age of 62.8 years and mean weight of 183.3 lbs. The patients were evaluated at a pre-operative and post-operative appointment for knee ROM measurement and Knee Survey Score (KSS) findings. The average follow-up time ranged from 2 to 6 months with a mean of 3.75 months. All patients were involved in a physical therapy program to improve knee ROM, strength, and functional outcomes following lateral approach TKA. OBSERVATIONS: With the lateral TKA approach, the final ROM and Knee Survey Score (KSS) demonstrated marked improvements. The average pre-operative knee ROM was 0-106.0 degrees and the average KSS was 59.2. The post-operative knee ROM was 0-116.7 degrees and the average KSS was 95.1. There were some physical therapy complications seen with the lateral approach. All but one of the complications were resolved with adequate physical therapy and/or surgical interventions. Six patients experienced knee flexion deformities, one patient had wound problems, one patient had difficulty walking due to muscle weakness, three patients had loss of knee flexion to only 90 degrees, three patients complained of knee stiffness, two patients had peroneal nerve dysfunction, and one patient with malaignment of the prosthesis. There were several interventions to resolve the complications after lateral TKA. Most of the complications were treated with aggressive physical therapy and custom knee device (CKD) bracing. Two of the patients had a manipulation under general anesthesia, one peroneal nerve release was performed, and two patients had revision total knee arthroplasty. One of the patients is still experiencing decreased knee extension ROM, stiffness, and pain. All other patients report good functional outcomes and knee range of motion. CONCLUSIONS: The complications associated with the lateral approach TKA are similar to those seen with midline approach to TKA. Twenty-three of the 24 patients reported good outcome at final follow-up. Out of the patients with complications, most complications were resolved with physical therapy intervention and CKD bracing. The final knee ROM measurements seen with the lateral approach TKA are higher than the average seen with TKA with traditional approach. Patients demonstrated faster rehabilitation and improved function with the lateral approach TKA. Overall, the lateral approach TKA has had few complications and with adequate physical therapy intervention has shown final outcome measures superior to traditional TKA approach. FUNDING SOURCE: None KEYWORDS: TKA, Lateral Approach Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.