Early Patient Outcomes After Primary Total Knee Arthroplasty with Quadriceps-Sparing Subvastus and Medial Parapatellar Techniques: A Randomized, Double-Blind Clinical Trial

Overview

Journal J Bone Joint Surg Am

Specialties General Surgery
Orthopedics

Date 2014 Jun 5

PMID 24897738

Citations 4

Authors

Ivan M Tomek

Stephen R Kantor

LuAnne A Cori

Jennifer M Scoville

Margaret R Grove

Tamara S Morgan

Ishaan Swarup

Wayne E Moschetti

Kevin F Spratt

Affiliations

Soon will be listed here.

Abstract

Background: Techniques that reduce injury to the knee extensor mechanism may cause less pain and allow faster recovery of knee function after primary total knee arthroplasty. A quadriceps-sparing (QS) subvastus technique of total knee arthroplasty was compared with medial parapatellar arthrotomy (MPPA) to determine which surgical technique led to better patient-reported function and less postoperative pain and opioid utilization.

Methods: In this prospective, double-blind study, 129 patients undergoing total knee arthroplasty were randomized to the QS or the MPPA group after skin incision. All surgical procedures utilized minimally invasive surgery principles and standardized anesthesia, implants, analgesia, and rehabilitation. The Knee Society Score (KSS) was obtained at baseline and one and three months after surgery. Weekly telephone interviews were used to collect patient-reported outcomes including ambulatory device use, the UCLA (University of California Los Angeles) activity score, performance of daily living activities, and opioid utilization.

Results: No differences between groups were seen in opioid utilization, either during the acute hospitalization or in the eight weeks after surgery. The QS group reported significantly less pain at rest on postoperative day one and with activity on day three (p = 0.04 for each). Compared with baseline, both groups showed significant improvements in the KSS at one month (MPPA, p = 0.0278; QS, p = 0.0021) and three months (p < 0.0001 for each) as well as week-to-week gains in walking independence through five weeks after surgery. Independence from ambulatory devices outside the home lagged behind independence indoors by about two weeks in both groups.

Conclusions: When primary total knee arthroplasty was performed with contemporary minimally invasive surgery principles and standardized implants, anesthesia, and postoperative pathways, the QS technique yielded no significant early functional advantages or differences in opioid utilization compared with the MPPA technique. However, the mean pain scores reported by patients in the QS group were slightly lower at rest on postoperative day one and during activity on day three.

Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Citing Articles

Comparisons of the Efficacy and Safety of Total Knee Arthroplasty by Different Surgical Approaches: A Systematic Review and Network Meta-analysis.

Zhao J, Zeng L, Pan J, Liang G, Huang H, Yang W Orthop Surg. 2022; 14(3):472-485.

PMID: 35128816 PMC: 8927026. DOI: 10.1111/os.13207.

Variation in perioperative opioid use after total joint arthroplasty.

Schumacher C, Menendez M, Pagani N, Freiberg A, Kwon Y, Bedair H J Orthop. 2021; 25:162-166.

PMID: 34025059 PMC: 8131953. DOI: 10.1016/j.jor.2021.05.003.

Promising early outcomes of a novel anatomic knee system.

Galea V, Botros M, Madanat R, Nielsen C, Bragdon C Knee Surg Sports Traumatol Arthrosc. 2018; 27(4):1067-1074.

PMID: 30361753 DOI: 10.1007/s00167-018-5248-0.

Medial subvastus the medial parapatellar approach for total knee replacement: A systematic review and meta-analysis of randomized controlled trials.

Berstock J, Murray J, Whitehouse M, Blom A, Beswick A EFORT Open Rev. 2018; 3(3):78-84.

PMID: 29657848 PMC: 5890136. DOI: 10.1302/2058-5241.3.170030.

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