Primary Total Knee Arthroplasty Performed With a Minimally Invasive Surgery Subvastus Approach

Abstract

| ABSTRACTThe subvastus surgical approach to total knee arthroplasty preserves the insertion of the vastus medialis tendon on the patella, thereby resulting in superior functional outcomes in the short term. This surgical approach was adapted to perform a consecutive series of primary uncemented total knees, without a thigh tourniquet, using a short-length incision. The outcomes are reported herein.One hundred fifteen primary total knees were performed using instrumentation optimized for minimally invasive surgery. Porous implants, including a monoblock trabecular metal tibial component, were implanted in each knee. Mean incision length was 4 in. Mean patient age was 67 years, and mean patient weight was 188 lb. No tourniquet was used in any knee, and a standard rehabilitation protocol was used with full weight-bearing after the operation.At a minimum follow-up of 12 months after surgery, 1 knee had undergone repeat surgery to revise a loose patella component. This complication was most likely related to an undisplaced patella fracture that occurred when the patient fell in the postoperative period. Another patient developed a deep venous thrombosis. No other complications occurred, and radiographs demonstrated satisfactory component positioning. Mean knee arc of motion at 4 weeks after surgery was 114 degrees, and most patients did not require formal physical therapy after a month after the operation.Because no muscle or tendon detachment is involved, the subvastus approach is ideally suited for minimally invasive surgery, especially if a thigh tourniquet is not used. The present series illustrates the safety, consistency, and reliability of this technique in a consecutive series of patients with knee arthritis. Faster patient recovery and greater patient satisfaction were achieved, without increased complications.