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Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study

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Abstract

Purpose

Whether minimally invasive total knee arthroplasty (MIS-TKA) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial. This prospective and randomized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA.

Methods

Fifty patients, including 50 knees, who required TKA due to osteoarthritis were randomized to the mini-subvastus group (group I) or the medial parapatellar group (group II). All patients accepted the same method of anaesthesia, equal support therapy and identical rehabilitation exercise after surgery. The evaluation system included operation time, tourniquet time, blood loss, skin incision length in flexion, straight leg raising time, the time of lower limb muscle strength up to grade 4, the time of walking with aid or without aid, the time of walking up and down the stairs, the active flexion angle, range of movement (ROM), the Knee Society Scores (KSS), visual analogue score for pain (VAS), hospital stays and radiographic outcomes.

Results

The mini-subvastus approach offered smaller skin incision length in flexion, but at the cost of operation time (P < 0.001). No significant difference was found in tourniquet time and blood loss. The patients in group I could achieve straight leg raising, the lower limb muscle strength up to grade 4, walking with or without aid, and walking up and down the stairs earlier (P < 0.001). The active flexion angle, ROM, VAS and KSS in group I were superior to those in group II until six months post-operatively (P < 0.001), but the differences was not apparent at 12 months post-operatively. More importantly, there was no significant difference between the two groups on radiological outcomes (P > 0.05).

Conclusions

The mini-subvastus approach could offer faster recovery, less pain and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the medial parapatellar approach.

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Author information

Author notes

  1. Ziyu Li and Wendan Cheng contributed equally to this work and should be considered as first authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China

    Ziyu Li, Wendan Cheng, Yunfeng Yao, Qiliang Cao, Shuming Ye, Lei Qi & Juehua Jing

  2. Department of Orthopaedic Surgery, Lu’an Affiliated Hospital of Anhui Medical University, Lu’an, China

    Liangye Sun, Shenglin Xu & Xiaosan Wu

Authors
  1. Ziyu Li
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  2. Wendan Cheng
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  3. Liangye Sun
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  4. Yunfeng Yao
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  5. Qiliang Cao
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  6. Shuming Ye
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  7. Lei Qi
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  8. Shenglin Xu
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  9. Xiaosan Wu
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  10. Juehua Jing
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Corresponding author

Correspondence to Juehua Jing.

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On behalf of all the authors, the corresponding author states that there is no conflict of interest.

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Li, Z., Cheng, W., Sun, L. et al. Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study. International Orthopaedics (SICOT) 42, 543–549 (2018). https://doi.org/10.1007/s00264-017-3703-z

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  • DOI: https://doi.org/10.1007/s00264-017-3703-z

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