Outcome of subvastus approach in elderly nonobese patients undergoing bilateral simultaneous total knee arthroplasty: A randomized controlled study

Abstract

Background:Subvastus approach in total knee arthroplasty (TKA) spares the quadriceps and may assist in faster rehabilitation. The present randomised controlled study was conducted to determine if the subvastus approach results in early recovery, faster mobilization, shorter hospital stay, and improved function.Materials and Methods:100 patients undergoing simultaneous bilateral TKA were randomized into two groups: subvastus group and medial parapatellar group. The patients were assessed clinically using VAS, time to straight leg raise, ability to stand with walker, ability to use a commode chair, ability to climb stairs, flexion at discharge, and day of discharge. Perioperative blood loss and duration of surgery were also compared. The patient were kept on same pain management and physiotherapy protocol. The evaluation was done at day 0,1,3 and at discharge. Statistical analyses tested the null hypotheses of no differences in patients treated with either group at 95% significance level (P < 0.05).Results:The VAS score was significantly lower in subvastus group on day 1 and day 3. Also mean hospital stay was 2.04 days less in subvastus group. Patients with subvastus approach were able to perform straight leg raising 0.44 days earlier. Though time to stand with walker was same for both groups, the ability to use commode chair, and climb stairs was significantly early (P < 0.05) in the subvastus group. The average flexion at the time of discharge in subvastus and parapatellar group were 100.8 and 96.8°, respectively. The mean perioperative blood loss in subvastus group and parapatellar group were 343 ml and 372 ml, respectively. Average surgical time required for subvastus approach and parapatellar approach were 108.5 and 94.3 min, respectively.Conclusions:Subvastus approach produce appreciably less pain and faster mobilization due to lesser insult to quadriceps, thus assisting in early rehabilitation, shorter hospital stay, less expenditure, and more patient satisfaction.

Subvastus Exposure Compared to Parapatellar Approach in Navigated Sequential Bilateral Total Knee Arthroplasty (SBTKA): A Prospective Randomized Study

“…There is only one study in which these two approaches have been compared in SBTKA patients. 22 This study was on the elderly (>70 years), nonobese patients and found that SVA decreases hospital stay and pain scores in the select group of patients. However, this study analyzed patients only till day of discharge and did not follow up the patients on short-or long-term basis.…”

Comparison of the quadriceps-sparing and subvastus approaches versus the standard parapatellar approach in total knee arthroplasty: a meta-analysis of randomized controlled trials

“…After removing 165 duplicates, 258 studies were reserved for abstract screening and full-text screening. Finally, nineteen RCTs [ 12 , 14 , 16 , 18 – 26 , 30 – 36 ] were considered to be eligible for meta-analysis. Of the included studies, nine [ 14 , 17 , 19 , 22 , 31 – 35 ] RCTs comparing the quadriceps-sparing approach with the standard parapatellar approach and ten [ 12 , 16 , 18 , 20 , 21 , 23 – 26 , 30 ] comparing the subvastus approach with the standard parapatellar approach were included.…”

“…Ten RCTs [ 12 , 16 , 18 , 20 , 21 , 23 – 26 , 30 ] comparing the subvastus with the standard parapatellar approach were included for meta-analysis (Table 4 ).…”

Indian Journal of Orthopaedics: Journey continues

“…Jain, et al . compared a series of cases of TKA operated by medial parpatellar approach and subvastus approach and found later approach superior interm of pain relief and postoperative mobilization 15. Sancheti et al .…”