Surgical Technique

Lateral approach for total knee arthroplasty in patients with valgus deformity: A step-by-step surgical technique

¹ Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
² Joint Surgery Group, Department of Orthopaedics, Peking University International Hospital, 102206 Beijing, China
³ School of Rehabilitation Health Sciences, University of Patras, Campus of University of Patras, Rio, 26504 Patras, Greece
⁴ Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 25 Avenue François Mitterand, 69622 Lyon, France
⁵ LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 43 Bd du 11 Novembre 1918, 69100 Villeurbanne, Lyon, France

^* Corresponding author: koutserimpas@upatras.gr

Received: 18 June 2025
Accepted: 19 July 2025

Abstract

Background: The lateral approach in total knee arthroplasty (TKA) is indicated primarily for patients with valgus knee deformity, as it allows direct access to the lateral anatomy and systematic correction of associated pathologies. Surgical Technique: This technique involves strategic lateral soft tissue releases, which improve exposure to the posterolateral corner, enhance tibial rotation, and support patellar alignment without compromising medial vascularity or requiring a tibial tubercle osteotomy for joint exposure. Critical steps in the lateral TKA approach include maintaining a capsular-synovial overlap and preserving the Hoffa fat pad for optimal joint closure, releasing the lateral soft-tissue structures, and using a contralateral tibial cutting guide for enhanced access and protection of the patellar tendon. Discussion: These techniques collectively allow for a balanced, stable joint with effective alignment and soft tissue management. Outcomes of the lateral approach in valgus TKA are comparable to those of the medial approach, with similar functional outcomes, range of motion, and surgical time. Some studies even report superior patellar tracking and function scores with the lateral approach. Complication rates are low, though attention is required to avoid peroneal nerve injury in severe deformities. Future research involving large, randomized controlled trials is recommended to substantiate these favorable outcomes and guide long-term treatment strategies for valgus TKA.