Subvastus and Medial Parapatellar Approaches in TKA: Comparison of Functional Results

Abstract

The purpose of this study was to compare the clinical results of total knee arthroplasty (TKA) in the early and late postoperative period using subvastus and medial parapatellar approach. A prospective randomized controlled study was conducted in a group of 169 patients (180 TKAs) with 2-year follow-up. Patients were divided into a study group (97 TKAs) with a subvastus approach and a control group (83 TKAs) with a parapatellar approach. Assessment of the results of both operating approaches was based on functional, clinical Knee Society Score, and pain (visual analog scale). Patients in the subvastus group achieved full active extension, better range of motion, and better Knee Society Score results at 12 days, 6 weeks, and 12 weeks earlier than patients in the medial parapatellar group. They also had less pain at 12 days. No statistically significant differences existed between assessed end points in both groups at 24- and 52-weeks, and 24-months postoperatively. The subvastus approach has given patients better early clinical results; however, at longer follow-up, both groups had similar outcomes. The potential benefits of the subvastus approach are: protection of the extensor mechanism from damage, less risk of damaging the blood supply to the patella, earlier clinical recovery, and less pain in the early postoperative period. The subvastus approach is an alternative to the standard medial parapatellar approach in TKA. It can be used with equally good results, especially taking into consideration positive clinical aspects in the early postoperative period.

Subvastus Versus Medial Parapatellar Approach in Total Knee Arthroplasty: Meta-analysis

“…Nine studies that met the inclusion criteria were included in the meta- analysis (Figure 1). 10,[14][15][16][19][20][21][22][23] Of the included trials, 8 were randomized controlled trials 10,14-16,19-22 and 1 was a quasirandomized, controlled trial (randomized by hospital number). 23 In addition, 2 quasirandomized, controlled trials (randomized by surgeon) were excluded 11,24 because the data were unavailable for meta-analysis.…”

Comparison of the Minimally Invasive and Standard Medial Parapatellar Approaches for Total Knee Arthroplasty: Systematic Review and Meta-Analysis

“…Thus, surgeons usually suggest that up to 1 year of rehabilitation may be required before full functional recovery can be achieved. 3 Extensive interest in the use of minimally invasive techniques in orthopaedics has been mainly attributed to market-and patient-driven demand. 4 Several such techniques have been described, including the mini-midvastus (MV), medial faster functional recovery, shorter hospital stays and better early range of motion (ROM) in the knee, have been reported for minimally invasive techniques compared with standard MP.…”

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

“…13 There are some randomized studies comparing the two approaches in unilateral TKA, having contradictory results, some favoring SVA while others showing no difference. [14][15][16] There are a few studies comparing SVA and MPA in bilateral TKA with one knee exposed by SVA and the other one by MPA showing no difference between two groups. 17 However, there are no studies comparing the two approaches in navigated sequential bilateral total knee arthroplasty (SBTKA).…”