Early functional outcome after subvastus or parapatellar approach in knee arthroplasty is comparable

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 19; no. 6; pp. 943 - 951
• Main Authors: van Hemert, Wouter L.W., Senden, Rachel, Grimm, Bernd, van der Linde, Matthijs J.A., Lataster, Arno, Heyligers, Ide C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.06.2011; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Arthritis; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Bursa; Cadaver; Dissection; Double-Blind Method; Female; Follow-Up Studies; Humans; Joint replacement surgery; Joints; Knee; Knee Joint - anatomy & histology; Knee Joint - surgery; Knee Prosthesis; Knees; Male; Measurement; Medicine; Medicine & Public Health; Middle Aged; Objectives; Orthopedics; Osteoarthritis; Osteoarthritis, Knee - diagnostic imaging; Osteoarthritis, Knee - surgery; Pain; Pain Measurement; Patella - surgery; Patient satisfaction; Postoperative Care - methods; Prospective Studies; Quadriceps Muscle - surgery; Radiography; Range of motion; Range of Motion, Articular - physiology; Recovery of Function; Rehabilitation; Risk Assessment; scoring; Sports; Surgery; Techniques; Time Factors; Treatment Outcome; Knee replacement; Clinimetrics; Subvastus approach; Vastus medialis anatomy; Performance-based test
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-010-1292-0

Purpose In total knee arthroplasty, tissue-sparing techniques are considered more important, as functional gain could become more advantageous when early mobilization is commenced. The parapatellar approach is most often used, whereas the subvastus approach is a suitable alternative. Presently, it is unknown, according to true objective measurements, which of the two is most advantageous. Methods In this prospective randomized double-blind, short-term trial measurements (KSS, WOMAC, PDI, VAS, ability to perform) were obtained at day 1, day 3, 1 week, 6 weeks, and 3 months. Results The subvastus group ( n  = 20) showed only significantly less extension lag direct postoperative ( P  = 0.04) compared with the parapatellar group ( n  = 20). Other scores were not significantly different. The Dynaport ® knee test, an objective performance-based tool, could not demonstrate significant differences. A blunt anatomical dissection was carried out in both observational and histological to support findings. A dense innervation of the distal vastus medialis was found. This is at risk employing the subvastus approach. Both approaches harm the suprapatellar bursa. The vastus medialis sheath must be detached distally to open the knee joint. No true separate vastus medialis obliquus could be identified. Conclusion Comparable to literature, only mild advantage employing the subvastus approach was found, but only early postoperative and not objectively. As this approach is also not suitable in every case, we will continue to use the parapatellar approach.