Comparing the Sub-Vastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Meta-Analysis of Short-Term Outcomes

Authors

Mohamed Sukeik^{1, *,} , Mohammad Zain Sohail², Fahad Siddique Hossain³, Sattar AlShryda⁵, James Powell⁴

¹Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital – Al Khobar, Al Bandariyah, Al Khobar 34423, Saudi Arabia

²Department of Trauma and Orthopaedics, Addenbrooks Hospital, Cambridge University NHS Trust, Hills Rd, Cambridge CB2 0QQ, UK

³Department of Trauma and Orthopaedics, Walsall Healthcare NHS Trust, Walsall WS2 9PS, UK

⁴Department of Trauma and Orthopaedics, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9

⁵Department of Trauma and Orthopaedics, Al Jalila Children’s Hospital, Al Jaddaf Dubai, UAE

^*Corresponding author. Email: msukeik@hotmail.com

DOI

10.2991/dsahmj.k.210203.001How to use a DOI?

Keywords

Approach; knee arthroplasty; medial parapatellar; replacement; sub-vastus

Abstract

Proponents of the Sub-Vastus (SV) approach in primary Total Knee Arthroplasty (TKA) claim superior extensor mechanism function which results in earlier recovery after surgery. We performed a meta-analysis of randomized controlled trials comparing the SV and standard Medial Parapatellar (MPP) approaches in primary TKAs. The study was performed using the Cochrane handbook for systematic reviews guidelines. A total of 28 studies with 2171 patients were included and the mean age of the SV group was 68.2 [standard deviation, ±4.4] and of the MPP group was 68.4 (±3.85). The SV approach resulted in a significant improvement in flexion at day 3 postoperatively [mean difference (MD) = 6°; 95% confidence interval (CI), 0.37–11.71; p < 0.01], but this was not sustainable at 6 weeks, 3 months, and 12 months postoperatively. Similarly, despite a significant reduction in the visual analogue scale score at day 1 postoperatively (MD = −1.19; 95% CI, −1.70 to −0.68; p < 0.01), there was not enough evidence to support its superiority after that. The SV approach led to a reduction in days to straight leg raise (MD = −1.88; 95% CI, −2.45 to −1.31; p < 0.01) and lateral releases [relative risk = 0.49; 95% CI, 0.30–0.82; p < 0.01) with no difference in complication rates (p = 0.64) but at the expense of a prolonged operation (MD = 13 min; 95% CI, 9.41–16.69; p < 0.01). Our conclusion is that the SV approach provides an alternative to the MPP with some advantages in the first 3 days only after primary TKA surgery.

Copyright

© 2021 Dr. Sulaiman Al Habib Medical Group. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Mohamed Sukeik
AU  - Mohammad Zain Sohail
AU  - Fahad Siddique Hossain
AU  - Sattar AlShryda
AU  - James Powell
PY  - 2021
DA  - 2021/02/11
TI  - Comparing the Sub-Vastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Meta-Analysis of Short-Term Outcomes
JO  - Dr. Sulaiman Al Habib Medical Journal
SP  - 66
EP  - 73
VL  - 3
IS  - 2
SN  - 2590-3349
UR  - https://doi.org/10.2991/dsahmj.k.210203.001
DO  - 10.2991/dsahmj.k.210203.001
ID  - Sukeik2021
ER  -