# Feasibility of medial parapatellar approach in unicompartmental knee arthroplasty for moderate to severe varus deformity

## TL;DR

The study explores whether a specific surgical approach for knee replacement works in complex cases of severe varus deformity, showing early success but needing more research.

## Contribution

Preliminary evidence that the medial parapatellar approach in unicompartmental knee arthroplasty is feasible for moderate to severe varus deformity.

## Key findings

- All patients showed significant improvements in knee scores and range of motion after surgery.
- No major complications were observed during follow-up.
- Hip-knee-ankle angle improved significantly, indicating correction of deformity.

## Abstract

Unicompartmental knee arthroplasty (UKA) is well-established for mild varus deformity, but its application in moderate to severe varus cases remains technically challenging. This study aims to preliminarily evaluate whether adopting the traditional medial parapatellar approach in UKA procedures for these complex deformities can yield acceptable early outcomes.

A retrospective study was conducted. Between January 2023 and March 2024, 9 patients with moderate to severe varus deformity underwent medial UKA using a cemented fixed-bearing Link prosthesis by medial parapatellar approach. The cohort included 1 male and 8 females with a mean age of 65.3 years and mean weight of 60.6 kg. All procedures were performed by a single surgeon. Preoperative and final follow-up assessments included bilateral full-length standing radiographs for hip-knee-ankle angle (HKA), The Angle between the femoral mechanical axis and the tibial mechanical axis (hip-knee-ankle angle, HKA) was measured by software and recorded. The hip-knee-ankle (HKA) angle was reported directly as the angle between the femoral and tibial mechanical axes. The normal alignment range was defined as 178°–182°, with values below 178° indicating varus deformity and those above 182° indicating valgus deformity. Knee range of motion (ROM), Hospital for Special Surgery (HSS) score, and Knee Society Score (KSS). Statistical analysis was performed using SPSS 26.0, with P < 0.05 considered statistically significant.

The follow-up of 15.20 ± 1.95 months, all patients demonstrated primary wound healing without perioperative complications. Significant improvements were observed in all measured parameters: HSS score improved from 50.11 ± 3.41 to 92.11 ± 2.37 95% CI: (40.12, 43.88); KSS score from 59.89 ± 3.55 to 88.78 ± 2.49 95% CI: (27.65, 30.13); KSS function score from 44.44 ± 6.82 to 76.67 ± 7.07 95% CI: (28.33,36.12); ROM from 94.22 ± 1.92° to 122.67 ± 2.83° 95% CI: (26.60, 30.29); and HKA from 164.58 ± 4.16° to 176.64 ± 2.20°95% CI: (10.16, 13.98). All improvements were statistically significant (P < 0.001). No cases of aseptic loosening, unexplained pain, or polyethylene liner dislocation were observed during follow-up.

This preliminary experience suggests medial parapatellar approach for UKA in moderate to severe varus deformity may represent a technical option for carefully selected cases. However, these observations are limited by the small sample size and relatively short follow-up. Further validation through larger-scale studies with extended follow-up is warranted to establish long-term efficacy and safety.