Abstract
In this paper, we evaluated the difference between the modified subvastus approach and the medial parapatellar approach in total knee arthroplasty(TKA). We assessed the time of active straight-leg raise (SLR) post-operatively and the range of flexion of the operated knee at the tenth post-operative day, 6 weeks and 6 months, 12 months and 3 years. We investigated the degree of the patellar tilt and subluxation 24 months post-operatively. The patients who underwent the modified subvastus approach performed active SLR earlier (mean 0.5 days) than the medial parapatellar approach patients (mean 2.2 days). Knee flexion was better at the tenth post-operative day in the modified subvastus approach group compared to the medial parapatellar approach group. There was no statistical difference between the two groups with regard to the patellar tilt and subluxation. We conclude that the modified subvastus approach is recommendable in primary TKA.
Résumé
Nous avons évalué la différence entre l’abord médial para patellaire et l’abord modifié subvastus lors de la mise en place d’une prothèse totale du genou. Nous avons apprécié le temps de récupération post-opératoire de l’extension active du genou et le degré de flexion de celui-ci à 10 jours, 6 semaines, 6, 12 et 36 mois. Nous avons également exploré les complications rotuliennes, notamment subluxations à 24 mois. Les patients ayant bénéficié d’un abord subvastus récupèrent une extension active plus précoce (en moyenne de 0,5 jours), contre 2,2 jours pour l’abord médian. L’amélioration de la flexion du genou est également meilleure à 10 jours post-opératoire dans ce groupe. Il n’y a pas de différence significative entre ces deux groupes en ce qui concerne les problèmes rotuliens. Nous pensons que l’abord subvastus est à recommander dans la mise en place d’une prothèse totale du genou.
Similar content being viewed by others
References
Engh GA, Parks NL (1998) Surgical technique of the midvastus arthrotomy. Clin Orthop Relat Res 351:270–274
Fauré BT, Benjamin JB, Lindsey B, Volz RG, Schutte D (1993) Comparison of the subvastus and paramedian surgical approaches in bilateral knee arthroplasty. J Arthroplasty 8:511–516
Gomes LS, Bechtold JE, Gustilo RB (1988) Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop Relat Res 236:72–81
Hofmann AA, Plaster RL, Murdock LE (1991) Subvastus (southern) approach for primary total knee arthroplasty. Clin Orthop Relat Res 269:70–77
Holtby RM, Grosso P (1996) Osteonecrosis and resorption of the patella after total knee replacement: a case report. Clin Orthop Relat Res 328:155–158
In Y, Kim JM, Choi NY, Kim SJ (2007) Large thigh girth is a relative contraindication for the subvastus approach in primary total knee arthroplasty. J Arthroplasty 22:569–573
Matsueda M, Gustilo RB (2000) Subvastus and medial parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res 371:161–168
Pagnano MW, Meneghini RM (2006) Minimally invasive total knee arthroplasty with an optimized subvastus approach. J Arthroplasty 21:22–26
Roysam GS, Oakley MJ (2001) Subvastus approach for total knee arthroplasty: a prospective, randomized, and observer-blinded trial. J Arthroplasty 16:454–457
Scapinelli R (1967) Blood supply of the human patella. Its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br 49:563–570
Scuderi G, Scharf SC, Meltzer LP, Scott WN (1987) The relationship of lateral releases to patella viability in total knee arthroplasty. J Arthroplasty 2:209–214
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jung, Y.B., Lee, Y.S., Lee, E.Y. et al. Comparison of the modified subvastus and medial parapatellar approaches in total knee arthroplasty. International Orthopaedics (SICOT) 33, 419–423 (2009). https://doi.org/10.1007/s00264-007-0510-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-007-0510-y