Vastus medialis necrosis secondary to the combination of the subvastus and median parapatellar approaches for implantation of a total knee replacement

We describe a case where a subvastus approach was used for implantation of a primary total knee replacement, which subsequently became infected. Medial parapatellar approaches were then used for the revision surgery at weeks four and twelve after the primary procedure. Vastus medialis necrosis and lateral subluxation of the patella then followed. The patella was centralised electively by performing an open lateral release and semitendinosus tenodesis. This report therefore indicates that combining these two approaches over a short time interval set against a background of haematoma and infection can lead to ischaemic necrosis of the vastus medialis muscle and lateral subluxation of the patella.