Sub-vastus approach is more effective than a medial parapatellar approach in primary total knee arthroplasty: A randomized controlled trial

Abstract

5In a prospective single-center longitudinal randomized controlled trial 116 patients were 6 allocated to the sub-vastus approach, and 115 to the medial parapatellar approach. At one 7 week follow-up, compared to baseline, range of motion, Knee Society (KS) global, KS 8 knee, and KS pain scores were significantly better in the sub-vastus group. At the one year 9 follow-up WOMAC global and pain scores, SF36 physical function and role-physical 10 scores, and EuroQol utility and pain score were significantly better in the sub-vastus 11 group. The ease of exposure in the sub-vastus approach was significantly worse. There 12 was no significant difference in length of stay or analgesia intake. The sub-vastus approach 13 to total knee arthroplasty was more effective than a medial parapatellar approach at both 14 one week and fifty-two weeks post-operatively, but surgeons reported a less easy exposure 15 in the sub-vastus group. 16[ISRCTN44544446] 17 18

Physical and functional outcomes of total knee arthroplasty: a comparison of two surgical approaches

“…This trial found no statistically significant differences in pain scores but did reveal a trend favouring the MPa group at 6 weeks post-operatively, similar to Bridgman et al (2009). The results for pain did not agree with earlier studies that found less pain associated with the SVa (Faure et al, 1993;Cameron, 2001;Weinhardt et al, 2004;Bridgman et al, 2009).…”

“…The results for pain did not agree with earlier studies that found less pain associated with the SVa (Faure et al, 1993;Cameron, 2001;Weinhardt et al, 2004;Bridgman et al, 2009). For example, a trial conducted by Cameron, (2001) found less pain in the SVa group at day one post-operatively, but did not state whether the patient or assessor was blinded to the approach, which may have affected the outcome.…”

“…The highest quality trial in the review reported appropriate randomisation procedures, but their follow up extended only 3 months post-operatively (Kayler et al, 1988;Roysam et al, 2001). In one clinical trial published subsequent to this review (Bridgman et al, 2009) To this end, a single centre, prospective randomised controlled trial was conducted in a metropolitan hospital to further compare the SVa and MPa. Outcomes were assessed preoperatively, intra-operatively (for some outcomes), on days 1 to 3 post-surgery, and at discharge as well as at 6 weeks, 6 months, 12 months and 18 months post-surgery.…”

Early Patient Outcomes After Primary Total Knee Arthroplasty with Quadriceps-Sparing Subvastus and Medial Parapatellar Techniques

“…T echniques that reduce injury to the knee extensor mechanism may cause less pain and allow faster recovery of knee function after primary total knee arthroplasty 1 .…”

“…Quadriceps-sparing (QS) techniques, such as the subvastus approach, avoid incising the quadriceps muscle or tendon by retracting the knee extensor muscles laterally 3 . However, a QS technique can be more difficult in stiff knees or muscular patients, and there is a learning curve for surgeons new to the technique 1,4 . Systematic reviews have indicated that the quality of published trials is poor and no one technique can be considered superior on the basis of the available evidence 2,5 .…”