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

Abstract

The subvastus and medial parapatellar approaches are 2 commonly performed techniques in total knee arthroplasty, but the optimal approach for total knee arthroplasty remains controversial. The purpose of this study was to compare the effectiveness and safety of the subvastus vs medial parapatellar approach.The PubMed, Embase, Cochrane Library, Inter-Services Intelligence Web of Knowledge, and Chinese Biomedical Literature databases were searched for eligible quasi-randomized, controlled and randomized, controlled trials. Two authors independently extracted data and assessed the methodological quality of the included studies according to the Cochrane handbook version 5.1.0. Statistical analysis was performed using Review Manager version 5.1 software. Eight randomized, controlled trials and 1 quasi-randomized, controlled trial involving 940 primary total knee arthroplasties were included for meta-analysis. Meta-analysis revealed significant differences favoring the subvastus group in Knee Society Score in terms of function at 4 to 6 weeks (weighted mean difference [WMD]=5.09; 95% confidence interval [CI], 3.08 to 7.09; P<.01) and knee score at 12 months (WMD=2.17; 95% CI, 0.01 to 4.34; P=.05) and lateral retinacular release (odds ratio=0.34; 95% CI, 0.14 to 0.79; P=.01) when compared with the medial parapatellar approach. However, both groups showed similar results in range of motion (P>.05), operative time (WMD=2.15; 95% CI, -3.61 to 7.35; P=.42), blood loss (WMD= -31.07; 95% CI, -91.89 to 29.75; P=.32), hospital stay (WMD= -0.18; 95% CI, -0.67 to 0.31; P=.47), and postoperative complications (P>.05).

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

“…Our meta-analysis showed that the subvastus approach had significant advantages over the standard approach in VAS (postoperative 6 months), ROM (postoperative 1 week and 12 months), straight leg raise and lateral retinacular release, and no disadvantages were found associated with the subvastus approach. Our conclusion was a little different with the published meta-analysis [ 1 , 40 ]. Teng et al [ 1 ] performed a meta-analysis including 8 RCTs and 1 quasi-RCTs, and concluded that the subvastus approach improved KSS score and decreased lateral retinacular release compared with the parapatellar approach.…”

“…As the standard approach, the medial parapatellar approach has been popularized for the excellent operative visualization. However, this approach requires the compromise of peripatellar blood supply and the quadriceps muscle, which might cause avascular necrosis and anterior knee pain [ 1 ].…”

“…Some studies advocated the use of subvastus or quadriceps-sparing approach. They reported that these two approaches had significant advantages in knee society scores (KSS) [ 1 , 16 , 17 ], straight-leg raise [ 17 – 19 ], visual analogue score (VAS) [ 17 ] and range of motion (ROM) [ 16 , 18 , 20 , 21 ]. However, other studies did not support this viewpoint.…”

A Prospective Study of Subvastus Approach vs. Medial Parapatellar Approach for Total Knee Arthroplasty

“…There was no statistical significant difference between two groups in terms of duration of stay (p>0.05). This was similar to results obtained by Bourke, et al 11 and Teng et al 16 This shorter stay could be due to reduced pain in post-operative period and preservation of quadriceps mechanism in subvastus group and patients could have mobilised earlier in post-operative period.…”

“…Roysam and Oakley 13 Bridgman, et al 10 Dutka, et al 14 and Tomek, et al found similar results. But, no difference in pain was found between two groups according to Weinhardt, et al 12 Wouter, et al 15 and Teng, et al 16 in their studies. We used visual analogue score for measurement of severity of pain in post-operative period.…”