Comparing outcomes of medial parapatellar and subvastus approaches in total knee arthroplasty: a randomized controlled trial.

The medial parapatellar (MP) approach in total knee arthroplasty is more common, but the subvastus (SV) approach is less insulting to the quadriceps. Whether the SV approach affords better outcomes was investigated using 90 participants with knee osteoarthritis, randomized to receive either SV or MP approaches and followed for 18 months. The primary outcome was the American Knee Society Score (AKSS); secondary outcomes included pain, knee range, quadriceps lag, Oxford Knee Score, 3-m timed "Up and Go" test, days to straight leg raise, surgeon perceived difficulty, operation duration, and length of stay. Analysis (n = 76) revealed no significant difference in AKSS (P = .076) or other outcomes, except the following: AKSS Functional scores at 12 and 18 months, favoring the MP (P = .032 and P = .028 respectively); surgeon's perceived difficulty, favoring the MP (P = .001); and days to straight leg raise, favoring the SV (P = .044). This study found that the SV approach offers no clinical benefit over the MP approach.

Systematic review of medial parapatellar and subvastus approaches in total knee arthroplasty.

This systematic review was performed to compare the outcomes of the medial parapatellar and subvastus surgical approaches for total knee arthroplasty. Five studies, published between 1993 and 2001 met the inclusion quality standards for the review. The methodological quality of most studies was poor, and they were not sufficiently homogenous for meta-analysis. We found that the evidence was insufficient to demonstrate a clinical or statistically significant difference between the medial parapatellar and subvastus approaches to total knee arthroplasty across all outcomes. Further trials with robust methodology, objective and functional outcome measures, and follow-up beyond 6 to 12 months are required.