DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20221121
Published: 2022-04-25

subvastus approach to knee joint

A study to assess the clinical and functional outcome of sub-vastus approach for total knee arthroplasty

Tarun Gupta, Anuj Nigam, Pramod P. Neema, Murtuza Rassiwala

Abstract


Background: Osteoarthritis and rheumatoid arthritis affects all patients of age more than 50 years, requiring total knee replacement. There are two major approaches to total knee replacement- sub-vastus approach and medial parapatellar approach. There is no common consensus on superiority of sub-vastus approach. So, we undertook the present study to evaluate the functional and clinical outcome of total knee replacement via sub-vastus approach in terms of knee society clinical and functional scores and visual analog scale along with monitoring of range of motion in the post-operative knee in the follow up period.

Methods: The present prospective and observational study was conducted in the Department of Orthopaedics, Unique Super Speciality Hospital, Indore, Madhya Pradesh for a period of 12 from June 2019-May 2020 with sample size of 30 patients undergoing total knee arthroplasty. All the patients had undergone total knee replacement via sub-vastus approach. The functional and clinical results of our study were compared with available literature.

Results: The mean KFS and KCS scores showed a statistically significant improvement over a period of 12 months (p<0.05), while the mean ROM showed an improvement till 6 months (p<0.05) and then it remained stable till 12 months in comparison to 6 months (p>0.05).

Conclusions: On comparing the results of sub-vastus approach with the available literature we found a significant improvement in functional and clinical outcome with a stable improvement in range of motion with very few complications.


Keywords


Osteoarthritis, Total knee arthroplasty, Sub-vastus approach, Knee society score, VAS

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References


Grazio S, Balen D. Obesity: Risk factor and predictors of osteoarthritis. Lijec Vjesn. 2009;131:22-6.

Cila E, Güzel V, Ozalay M, Tan J, Simşek SA, Kanatli U et al. Subvastus versus medial parapatellar approach in total knee arthroplasty. Arch Orthop Trauma Surg. 2002;122(2):65-8.

Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26:355-69.

Fauré BT, Benjamin JB, Lindsey B, Volz RG, Schutte D. Comparison of the subvastus and paramedian surgical approaches in bilateral knee arthroplasty. J Arthroplasty. 1993;8:511‑6.

Varacallo M, Luo TD, Johanson NA. Total Knee Arthroplasty Techniques. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.

Bourke MG, Jull GA, Buttrum PJ, Fitzpatrick PL, Dalton PA, Russell TG. Comparing outcomes of medial parapatellar and subvastus approaches in total knee arthroplasty: a randomized controlled trial. J Arthroplasty. 2012;27(3):347-353.e1.

Gidwani S, Fairbank A. The orthopaedic approach to managing osteoarthritis of the knee. BMJ. 2004;329(7476):1220-4.

Morrison W. Knee Replacement: Your Surgical Options, 2018. Available at: https://www.healthline.com/health/totalknreplacement-surgery/surgicaloptions. Accessed on 22 January 2022.

Sanna M, Sanna C, Caputo F, Piu G, Salvi M. Surgical approaches in total knee arthroplasty. Joints. 2013;1(2):34-44.

Endres NK, Minas T. Medial subvastus approach to the knee: surgical technique, 2021. Available at: http://www.orthojournalhms.org/volume10/manuscripts/PDF/V10_62.pdf. Accessed on 22 January 2022.

Keating EM, Faris PM, Meding JB, Ritter MA. Comparison of the midvastus muscle-splitting approach with the median parapatellar approach in total knee arthroplasty. J Arthroplasty. 1999;14(1):29-32.

Maestro A, Suarez MA, Rodriguez L, Guerra C, Murcia A. The midvastus surgical approach in total knee arthroplasty. Int Orthop. 2000;24(2):104-7.

Matsueda M, Gustilo RB. Subvastus and medial parapatellar approaches in total knee arthroplasty. Clincal Orthop Related Res. 2000;(371):161-8.

Roysam GS, Oakley MJ. Subvastus approach for total knee arthroplasty: a prospective, randomized, and observer-blinded trial. J Arthroplasty. 2001;16(4):454-7.

Weinhardt C, Barisic M, Bergmann EG, Heller KD. Early results of subvastus versus medial parapatellar approach in primary total knee arthroplasty. Arch Orthop Trauma Surg. 2004;124(6):401-3.

Bonutti PM, Zywiel MG, Ulrich SD, Stroh DA, Seyler TM, Mont MA. A comparison of subvastus and midvastus approaches in minimally invasive total knee arthroplasty. J Bone Joint Surg Am. 2010;92(3):575-82.

Liu Z, Yang H. Comparison of the minimally invasive and standard medial parapatellar approaches for total knee arthroplasty: systematic review and metaanalysis. J Int Med Res. 2011;39(5):1607-17.

Masjudin T, Kamari Zh. A comparison between subvastus and midvastus approaches for staged bilateral total knee arthroplasty:a prospective, randomized study. Malays Orthop J. 2012;6(3):31-6.

Teng Y, Du W, Jiang J, Gao X, Pan S, Wang J et al. Subvastus versus medial parapatellar approach in total knee arthroplasty: meta-analysis. Orthopedics. 2012;35(12):e1722-31.

Shah NA, Patil HG, Vaishnav VO, Savale A. Total knee arthroplasty using subvastus approach in stiff knee: A retrospective analysis of 110 cases. Indian J Orthop. 2016;50(2):166-71.

Berstock JR, Murray JR, Whitehouse MR, Blom AW, Beswick AD. Medial subvastus versus the medial parapatellar approach for total knee replacement: A systematic review and meta-analysis of randomized controlled trials. EFORT Open Rev. 2018;3(3):78-84.

Mohammad KF, Santharam B, Girish B, Narayan P. A Prospective Study of Subvastus Approach vs. Medial Parapatellar Approach for Total Knee Arthroplasty. J. Evid. Based Med. Healthc. 2019;6:2349-562.

Sukeik M, Sohail MZ, Hossain FS, AlShryda S, Powell J. Comparing the Sub- Vastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Meta- Analysis of Short-Term Outcomes. Dr. Sulaiman Al Habib Med J. 2021.