Comparing early functional outcomes between the midvastus and medial parapatellar approach for total knee arthroplasty: A prospective cohort study in an Asian population

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-25 DOI:10.1016/j.jcot.2025.103033

Emrick Sen Hui Quah , Brian Rui Kye Chee , Lynn Thwin, Michael Gui Jie Yam

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引用次数: 0

Abstract

Background

The medial parapatellar approach is the most prevalent approach for total knee arthroplasty. However, recent studies have suggested that the midvastus approach may confer benefits of better functional outcomes in the early post-operative period. This study aims to explore the differences in early functional outcomes between the two approaches.

Methods

This is a prospective cohort study of 72 total knee arthroplasties performed in a single tertiary institution. Baseline demographics and functional status were collected. Patients were followed up at the following time points - post-operative day 0, 1, 2, day of discharge and at first follow up 4–6 weeks post-surgery. The primary outcomes were range of motion, ambulatory distance, use of mobility aids, ability to straight leg raise and quadriceps strength – adjuncts to approximate functional recovery. Secondary outcomes include pain scores, operative time, length of stay, presence of any peri-operative complications, and patient discharge destination.

Results

Patients in the midvastus group achieved a greater ambulatory distance on post-operative day 1 compared to those in the medial parapatellar group (median ambulation distance 30m versus 18m, p < 0.001). The time to straight leg raise was also shorter in the midvastus group (median duration 0 days vs 1 day, p = 0.016). There was no significant difference in length of stay, operative time or incidence of peri-operative complications.

Conclusion

The midvastus approach showed non inferior outcomes when compared to the classic medial parapatellar approach and may confer additional functional benefits in the form of shorter time to straight leg raise and longer ambulatory distances on post-operative day 1. Clinicians need to balance the purported benefits of the midvastus approach with the intraoperative technicalities of the midvastus approach, before deciding if it is suitable to be a standard approach to the knee in total knee arthroplasties.

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比较全膝关节置换术中股肌入路和内侧髌旁入路的早期功能结局：一项亚洲人群的前瞻性队列研究

背景髌旁内侧入路是全膝关节置换术中最常见的入路。然而，最近的研究表明，在术后早期，股中入路可能具有更好的功能预后。本研究旨在探讨两种方法在早期功能结果上的差异。方法：这是一项前瞻性队列研究，在一所高等院校进行了72例全膝关节置换术。收集基线人口统计数据和功能状态。随访时间分别为：术后第0、1、2天、出院当天及术后第一次随访4 ~ 6周。主要结果为活动范围、活动距离、活动辅助工具的使用、伸直腿的能力和股四头肌力量-辅助功能恢复。次要结局包括疼痛评分、手术时间、住院时间、任何围手术期并发症的存在和患者出院目的地。结果股骨中段组患者术后第1天的活动距离较髌旁内侧组大(中位活动距离30m vs . 18m, p <；0.001)。股中肌组直腿抬高的时间也较短（中位持续时间0天vs 1天，p = 0.016）。两组患者的住院时间、手术时间及围手术期并发症发生率均无统计学差异。结论：与经典内侧髌旁入路相比，股中入路的预后并不差，而且在术后第1天，可获得更短的伸直腿时间和更长的行走距离等额外的功能益处。临床医生在决定是否适合作为全膝关节置换术的标准入路之前，需要权衡股正中入路的益处和术中技术问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.