Quadriceps sparing (subvastus/midvastus) approach versus the conventional medial parapatellar approach in primary knee arthroplasty

Mehta, Nitin; Bhat, Mohd Shafi; Goyal, Ankit; Mishra, Pallav; Joshi, Deepak; Chaudhary, Deepak

doi:10.1016/j.jajs.2017.02.004

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…When comparing the outcomes of this MIV approach to the published outcomes of the SV, we found the average knee ROM by the end of the third postoperative month recorded for the MIV approach patients in this study was 129.13. Knee ROM reported at 3 months after surgery for patients who had TKA performed using the SV approach ranged from 87.1 to 120 11,15–21. The knee ROM for TKA patients 1 year after surgery for the MIV approach patients was 136.76, whereas average reported knee ROM after TKA performed utilizing the SV approach ranged from 96.1 to 127 11,15,16,18,19,22–24.…”

Section: Discussionmentioning

confidence: 99%

“…Knee ROM reported at 3 months after surgery for patients who had TKA performed using the SV approach ranged from 87.1 to 120. 11,[15][16][17][18][19][20][21] The knee ROM for TKA patients 1 year after surgery for the MIV approach patients was 136.76, whereas average reported knee ROM after TKA performed utilizing the SV approach ranged from 96.1 to 127. 11,15,16,18,19,[22][23][24] Knee ROM reported at the 2-year follow-up time for TKA patients treated using the SV approach ranged from 114 to 127, 22,24,25 and averaged 139.68 for patients treated using the MIV approach.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Functional Outcomes Following Modified Intervastus Approach

Sartawi

Rahman

Kohlmann

2021

Techniques in Orthopaedics

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Background: The modified intervastus (MIV) approach is a new muscle and tendon sparing approach to the knee that is easy to perform and compatible with more extensile approaches such as a quadriceps snip. The study reports the clinical and functional outcomes of patients undergoing total knee arthroplasty (TKA) using the MIV approach. These results will be compared with published results of TKA done utilizing the subvastus approach.Methods: A total of 84 patients underwent TKA using the MIV approach from 2017 to 2019. Clinical and functional outcomes were assessed by recording the knee injury and osteoarthritis outcomes score, visual analog scale for pain, and knee range of motion (ROM). Outcome data was collected preoperatively, on the day of surgery, and postoperatively at 2, 6 weeks, 3, 6 months, 1, and 2 years. Paired sample t tests were conducted to assess the statistical significance observed in the outcomes between different time intervals.Results: All patients were able to walk on the day of surgery. The knee ROM increased significantly by 2 weeks after surgery (9.36%) and a net improvement for knee ROM of 37.89% was observed by the end of 2 years (P < 0.001). Knee injury and osteoarthritis outcomes score improved by 226.35% and visual analog scale for pain decreased by 82.34% following 2 years of surgery (Ps < 0.001). Conclusion:The study reports impressive clinical and functional outcomes using the MIV approach. The approach is safe and affords adequate exposure for the majority of primary TKA cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical and Functional Outcomes Following Modified Intervastus Approach

Sartawi

Rahman

Kohlmann

2021

Techniques in Orthopaedics

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“…The incision then continues from the superior-medial border of the patella, around the medial border of the patella, and finally along the medial side of the patellar tendon ( Engh et al, 1997 ). This approach has been shown to provide short recovery time and better radiological results than the traditional approach ( Mehta et al, 2017 ). Both LPPA and MVA are reported to be superior to the traditional MPPA technique with higher tissue preservation and faster recovery ( Sekiya et al, 2014 ; Mehta et al, 2017 ) but the functional outcomes between LPPA and MVA surgical approaches have not been well documented.…”

Section: Introductionmentioning

confidence: 99%

“…This approach has been shown to provide short recovery time and better radiological results than the traditional approach ( Mehta et al, 2017 ). Both LPPA and MVA are reported to be superior to the traditional MPPA technique with higher tissue preservation and faster recovery ( Sekiya et al, 2014 ; Mehta et al, 2017 ) but the functional outcomes between LPPA and MVA surgical approaches have not been well documented. Since LPPA and MVA affect different muscles and soft tissues, identifying their effects on the functional performance will help provide guidelines for surgical approach selections for individual patients.…”

Section: Introductionmentioning

confidence: 99%

Mid-vastus total knee arthroplasty for medial osteoarthritis recovers gait balance control better than lateral parapatellar approach three months post-surgery

Lee

Wang

Chen

et al. 2023

Front. Bioeng. Biotechnol.

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Total knee arthroplasty (TKA) approaches affect recovery outcomes, with different levels of residual loss of muscle strength and functional deficits. The current study compared the gait balance control in older individuals 3 months after TKA via the lateral parapatellar approach (LPPA) and mid-vastus approach (MVA) in terms of the inclination angle (IA) of the center of pressure (COP) to the body’s center of mass (COM) vector, and the rate of change of IA (RCIA). In a gait laboratory, 12 patients with severe medial knee osteoarthritis who had undergone bilateral TKA via LPPA and 12 via MVA were evaluated and compared against 12 healthy controls for their balance control during gait 3 months after surgery. The participants’ kinematic data and ground reaction forces were measured synchronously using an 8-camera motion capture system and three forceplates, respectively, from which the COM, COP, IA and RCIA were calculated using a 13-body-segment model. The LPPA group showed significantly greater sagittal IA during DLS (p < 0.01) but less sagittal and frontal RCIA throughout the gait cycle (p < 0.04) compared to controls. The MVA showed better recovery in the balance control with most IA and RCIA variables similar to those of the healthy controls throughout the gait cycle. The patients with LPPA walked with a compromised balance control throughout the gait cycle while the MVA group showed close-to-normal balance control with a slight decrease in sagittal RCIA during SLS. The current between-approach findings were likely related to the differences in the muscles involved during surgery, suggesting that MVA may be a better choice than LPPA when taking short-term gait balance control into consideration.

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Better outcomes after mini-subvastus approach for primary total knee arthroplasty: a Bayesian network meta-analysis

Migliorini

Aretini

Driessen

et al. 2020

Eur J Orthop Surg Traumatol

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Introduction Alternatives to the classical medial parapatellar (MPP) approach for total knee arthroplasty (TKA) include the mini-medial parapatellar (MMPP), mini-subvastus (MSV), mini-midvastus (MMV) and quadriceps-sparing (QS) approaches. The best approach has been not fully clarified. The purpose of the present study was to conduct a Bayesian network meta-analysis comparing these approaches. Materials and methods The present analysis was carried out according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. The databases search was performed in October 2019. All clinical trials comparing two or more approaches for primary TKA were considered for inclusion. The baseline comparability was evaluated through the analysis of variance (ANOVA) test. The statistical analysis was performed through the STATA software/MP. A Bayesian hierarchical random-effects model analysis was adopted in all the comparisons. Results Data from 52 articles (4533 patients) were collected. The mean follow-up was 20.38 months. With regard to diagnosis, gender, age and BMI, adequate baseline comparability was detected. The MSV approach ranked better concerning clinical scores (the lowest visual analogic scale, the higher KSS and KSFS) and functional outcomes (the shortest straight leg raise, the greatest degree of flexion and range of motion). Concerning perioperative data, the MSV evidenced the shortest hospital stay, while the MPP the shortest surgical duration and lowest estimated blood loss. Conclusion According to the main findings of the present study, the mini-subvastus approach for total knee arthroplasty demonstrated superior overall compared to the other approaches. Orthopaedic surgeons should consider this approach in the light of the evidence and limitations of this Bayesian network meta-analysis.

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Quadriceps sparing (subvastus/midvastus) approach versus the conventional medial parapatellar approach in primary knee arthroplasty

Cited by 5 publications

References 19 publications

Clinical and Functional Outcomes Following Modified Intervastus Approach

Clinical and Functional Outcomes Following Modified Intervastus Approach

Mid-vastus total knee arthroplasty for medial osteoarthritis recovers gait balance control better than lateral parapatellar approach three months post-surgery

Better outcomes after mini-subvastus approach for primary total knee arthroplasty: a Bayesian network meta-analysis

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