Subvastus versus medial parapatellar approach in total knee arthroplasty

Abstract

The subvastus approach for total knee replacement was compared with the standard medial parapatellar approach in terms of postoperative knee scores and quadriceps strength. Two groups of patients with similar characteristics were formed: the first group consisted of 12 knees of 9 patients who were implanted via the medial parapatellar approach, and for the second group the subvastus approach was used in 10 knees of 10 patients. The groups' knee scores and quadriceps strength were compared preoperatively and postoperatively at week 6, months 3 and 6. The knee scores improved similarly in both groups, but the change was more pronounced in the subvastus group. Quadriceps strength was greater in the subvastus group at postoperative week 6, but there was no significant difference between the groups in months 3 and 6. It was concluded that although the subvastus approach offers greater quadriceps strength in the early postoperative period, it has no significant advantage in this aspect over the medial parapatellar approach.

Avaliação isocinética em pacientes submetidos à artroplastia total de joelho

“…We highlight that these studies compare to accesses hurting femoral quadriceps muscle. Cila et al 20 found a difference for strength between the access port under vastus medialis muscle and the transquadricipital access port with six weeks of surgery, but they did not find difference at three and six months. In our study, the functional scale score showed difference between groups at the end of rehabilitation program, which was not repeated when performing isokinetic evaluation at six months postoperatively.…”

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

“…The six unicompartmental knee arthroplasties were retained as the study was primarily investigating TKA, and it was desirable to include the TKAs in the same trial. Levels of evidence (National Health and Medical Research Council, 2007) ranged from level II randomised controlled trial (Roysam et al, 2001;Weinhardt et al, 2004) to level III-1 pseudo randomised controlled trial (Faure et al, 1993;Cameron, 2001;Cila et al, 2002).…”

“…The subvastus approach (SVa) is arguably more difficult and accesses the knee under the quadriceps muscle . This surgical approach purportedly affords better outcomes with research demonstrating better quadriceps function (Faure et al, 1993;Cameron, 2001;Roysam et al, 2001;Cila et al, 2002;Weinhardt et al, 2004), and less pain (Cameron, 2001;Roysam et al, 2001;Weinhardt et al, 2004) when compared to the MPa. There are, however, inconsistent findings on other outcomes.…”

“…To address the seeming lack of concordance in the literature, a systematic review which focused on the quality of the methodology of the research that investigated the outcomes of the SVa when compared to the MPa was required. The review found only five studies that compared the relative merits of these two arthrotomies (Faure et al, 1993;Cameron, 2001;Roysam et al, 2001;Cila et al, 2002;Weinhardt et al, 2004) and due to study design limitations including randomisation and blinding concerns, firm conclusions about the superiority of either approach was not possible.…”

“…The SVa aims to preserve the quadriceps muscle and patellar vascularity with dissection performed deep to the vastus medialis muscle. Preservation of the quadriceps during TKA is argued to result in less pain, earlier functional recovery, and shorter length of hospital stay Faure et al, 1993;Matsueda et al, 2000;Cameron, 2001;Roysam et al, 2001;Cila et al, 2002). Other proposed advantages of the SVa include a reduction in analgesic requirements, earlier improvement in muscle strength and earlier independent straight leg raising Faure et al, 1993;Matsueda et al, 2000;Roysam et al, 2001).…”