Comparative Analysis of Functional Outcome of Conventional Midline Parapatellar to Minimally Invasive Subvastus Approach in Total Knee Replacement
Background: Minimally invasive subvastus total knee replacement (TKR) has gained popularity over the past few years. Early results of this minimal invasive TKR have shown no clear advantage over conventional longer midline parapatellar approach in relation to the functional outcome and recovery. Hence we analyzed and compared the functional outcome of conventional midline longer parapatellar approach with minimal invasive subvastus approach in TKR surgery.
Material and methods: All cases operated for TKR by two approach minimally invasive subvastus approach or conventional midline parapatellar approach were compared for length of incision, amount of blood loss (drain in first 24-hrs), tourniquet time, visual analogue pain score, range of motion, straight leg raising (SLR), length of hospital stay, knee functional & objective society scores.
Results: 40 patients with mean age 65.3 years (range 59 to 72 years) of osteoarthritis knee who underwent TKR by conventional midline parapatellar approach or minimal invasive subvastus approach were included in the study. 27 were female and 13 were male. The mean incision length, mean tourniquet time and mean total blood loss in conventional midline parapatellar approach group was 18.85 cm (range 17 to 19 cm), 65.5 min (range 60 to 70 min) and 347.6 ml (range 240 to 460 ml) respectively. The mean incision length, mean tourniquet time and mean total blood loss in minimal invasive subvastus approach group was 10.30 cm (range 9 to 11 cm), 85 min (range 80 to 90 ml) and 293.35 ml (range 175 to 409 ml). The mean length of hospital stay was same in both the groups 6.8 days (range 5 to 9).
Conclusion: TKR by conventional midline parapatellar approach demonstrated better functional outcome, reduced operative time, reduced tissue trauma (lesser pressure by retractors), shorter learning curve, easier availability of implant and instrument sets and precise implant placement due to a good visualization of the surgical field in comparison to minimal invasive subvastus approach. Hence conventional midline parapatellar approach method which is tried and time tested, still holds important corner stone in TKR surgery and should be given due consideration.
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