The two main concerns for patients prior to total knee arthroplasty (TKA) are pain and length of recovery.Obtaining satisfactory results with standard parapatellar(traditional ) approach may require a long recovery period.
Subvastus approach produce appreciably less pain and faster mobilization due to lesser insult to quadriceps, thus assisting in early rehabilitation, shorter hospital stay, less expenditure, and more patient satisfaction.
Early rehabilitation after a total knee arthroplasty (TKA) is desirable for patient satisfaction and to minimize the postoperative complications. Though there are many approaches for TKA, medial parapatellar approach is the most common approach. It is an extensile approach and provides adequate working space, but breach in the quadriceps mechanism has been considered a major disadvantage. The impairment of the blood supply to patella(knee cap) has also been mentioned as a disadvantage . Subvastus approach preserves the integrity of the quadriceps muscle as well as the patellar blood supply thus allowing faster rehabilitation. The other advantages are decreased postoperative analgesics requirement and reduced hospital stay. Rehabilitation in early postoperative period has been shown to be better by subvastus approach as compared to medial parapatellar approach. The early strength advantage, potential anatomic, and vascular benefits of subvastus approach make it a viable alternative to the traditional parapatellar approach.
The major disadvantage is that, the technique is demanding and has a long learning curve.
The quadriceps strength is better in subvastus group as evidenced by early ability to climb stairs and use commode chair. This faster rehabilitation can also be attributed to less pain in subvastus approach group as the quadriceps mechanism remains intact. Other advantage of subvastus approach was shorter hospital stay, which significantly cuts down the expenses for the patient (approx. 10-15% less in our hospital) and add to overall patient satisfaction.
To conclude, one of the main factors which limit the postoperative rehabilitation in elderly patients undergoing bilateral simultaneous TKA with parapatellar approach is pain and delayed mobilization. We at our centre believe that subvastus approach produce appreciably less pain and faster mobilization as compared to traditional parapatellar approach and shorter hospital stay, and more patient satisfaction.
Total knee replacement with parapatellar approach
Total knee replacement with MINIMALLY INVASIVE SUBVASTUS APPROACH
After closing the extensor mechanism. The complete extensor mechanism is kept intact.
