A Prospective Study of Subvastus Approach vs. Medial Parapatellar Approach for Total Knee Arthroplasty

Abstract

BACKGROUND Among the various surgical approaches for total knee arthroplasty, medial parapatellar and subvastus approach are two commonly used surgical approaches in total knee arthroplasty. The aim of this study is to compare the functional outcome between subvastus approach and medial parapatellar approach. METHODS This is a prospective study which compared medial parapatellar approach (Group-1, 30 patients) and subvastus approach (Group-2, 30 patients) from November 2017 to March 2019, in Rajarajeswari Medical College and Hospital, Bangalore. Patients were followed up for 16 months. Revision knee arthroplasty cases and total knee arthroplasty cases operated by other surgeons were excluded. RESULTS There was no significant difference between subvastus approach and medial parapatellar approach. Except that in subvastus approach, quadriceps tendon was not disrupted. Pain was better controlled in subvastus approach on post-operative day but operative time was more in subvastus group. There were no difference between two groups with regard to duration of stay, blood loss and post-operative complications. CONCLUSIONS Subvastus approach provided better pain relief postoperatively, but operative time was more in subvastus group. There was no significant difference between the two groups in duration of stay and post-operative complications. Subvastus can also be considered as an alternative surgical approach along with standard medial parapatellar approach for primary total knee arthroplasty.

Comparing the Sub-Vastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Meta-Analysis of Short-Term Outcomes

“…Having retrieved the full articles of the rest of the studies and analyzing them, nine further studies were excluded according to the inclusion and exclusion criteria (Figure 1). Twenty-five RCTs [5][6][7]11,13,14,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] and three quasi-RCTs [10,12,38] were analyzed in the final meta-analysis (Table 1).…”

“…Minimally invasive surgery was used in nine of the SV studies [6,10,12,23,29,31,33,35,37] whereas the rest of the studies used a standard midline incision. Application of a tourniquet was mentioned in 15 studies [6,[11][12][13][14]20,21,23,26,30,31,[33][34][35][36]. There were four studies that mentioned using regional anesthesia only [12,24,29,38], two studies used general anesthesia [13,35], and two studies used both regional and general anesthesia [7,33].…”

“…A surgical drain was used in 17 studies [5][6][7][10][11][12][13][14]20,21,23,24,[29][30][31]35,36]. Thromboprophylaxis strategy was detailed in studies and included chemical prophylaxis in nine studies [6,11,13,14,23,26,29,31,38], mechanical prophylaxis only in one study [20], and a combination of both in one study [12]. DVT screening was followed in one study and included routine ultrasound of all cases in the postoperative period [12].…”

“…In 13 studies [5,11,19,21,22,26,27,30,32,[34][35][36][37], the random sequence generation was insufficient to permit judgment regarding selection bias. The sequence was generated by admission number (odd or even) or on an alternate basis on admission in the quasi-RCTs [10,12,38].…”

“…risk for selection bias in one study [25]. The blinding of participants and outcome assessors was unclear in a number of studies [10,14,19,22,[25][26][27]31,32,[34][35][36][37], and two studies [20,27] had loss of patients at follow-up and hence classified as high risk for attrition bias. There were no concerns in relation to reporting bias or any other types of bias in the studies included (Figures 2 and 3).…”