Comparable long-term functional outcomes of subvastus and medial parapatellar approach in total knee arthroplasty: A 10-year follow-up study

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-10-08 DOI:10.1002/jeo2.70035

Pooya Hosseini-Monfared, Alireza Mirahmadi, Shayan Amiri, Reza Minaie, Mohammad Hossein Ghafouri, Seyed Morteza Kazemi

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Abstract

Background

Surgeons usually use the medial parapatellar or subvastus approaches for total knee arthroplasty (TKA). The subvastus approach is rapidly gaining recognition to reduce damage to the extensional mechanism and recover faster after surgery. This study compares the long-term outcomes of the conventional medial parapatellar and subvastus approaches in primary TKA during a minimum 10-year follow-up.

Methods

In a retrospective longitudinal follow-up study from 2008 to 2013, 60 eligible patients for primary TKA were included. The patients were divided into two groups: one undergoing TKA with the subvastus approach (n = 30) and the other with the conventional medial parapatellar approach (n = 30). Postoperatively, the patients were followed up for 10–15 years. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Visual Analogue Scale index for pain.

Results

The time required to perform an active straight leg raise (SLR) was significantly shorter in the subvastus group (p < 0.001) at early postoperation evaluation. Patients in the subvastus group had lower pain and better knee functional scores at the one-year follow-up (p < 0.05). There was no difference between the two groups regarding duration of hospitalisation, blood loss, operation time, length of the scar, and postoperative complications. Both approaches had similar long-term results regarding pain and functional scores of WOMAC (6.2 ± 1.2 vs. 6.3 ± 1.3, p-value = 0.69) and KSS scores (93.1 ± 6.8 vs. 95.0 ± 3.2, p-value = 0.42).

Conclusion

The subvastus approach was associated with a shorter time to achieve active SLR, higher functional scores, and better pain relief at early postoperative evaluations. However, both techniques had similar long-term outcomes in terms of pain and functional scores, as measured by the WOMAC and KSS scales.

Level of Evidence

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在全膝关节置换术中，髌下和髌旁内侧入路的长期功能效果相当：10 年随访研究。

背景：外科医生通常采用内侧髌旁或腹膜下入路进行全膝关节置换术（TKA）。腹膜下入路可减少对伸展机制的损伤，术后恢复更快，因此迅速得到认可。本研究比较了传统的内侧髌旁入路和腹膜下入路在初级 TKA 中至少 10 年随访的长期疗效：在 2008 年至 2013 年的一项回顾性纵向随访研究中，共纳入了 60 名符合条件的原发性 TKA 患者。患者被分为两组：一组采用腹股沟下入路（30 人），另一组采用传统的内侧髌旁入路（30 人）。术后对患者进行了长达 10-15 年的随访。采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、膝关节社会评分（KSS）和疼痛视觉模拟量表指数对患者进行评估：结果：主动直腿抬高（SLR）所需时间在腹膜下组显著缩短（p p p值=0.69），KSS评分（93.1 ± 6.8 vs. 95.0 ± 3.2，p值=0.42）也显著缩短：结论：在术后早期评估中，腹膜下入路与实现主动 SLR 的时间更短、功能评分更高以及疼痛缓解更好相关。然而，两种方法在疼痛和功能评分方面的长期疗效相似，均采用 WOMAC 和 KSS 量表进行测量：证据等级：II。

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