Surgical treatment of knee osteoarthritis with total knee arthroplasty: A retrospective study on traditional parapatellar approach vs modified subvastus approach

ABSTRACT Background Knee osteoarthritis (OA), also known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage. It is most common in the elderly. Total knee arthroplasty (TKA) is indicated for the relief of severe knee pain that is refractory to nonoperative treatments. To comprehensively evaluate the clinical effectiveness of the traditional parapatellar approach versus the modified subvastus approach, a retrospective analysis was conducted focusing on pain relief, knee function recovery, complication rates, and quality of life improvement. Methods A total of 145 patients with knee osteoarthritis who underwent total knee arthroplasty via medial parapatellar approach and modified subvastus approach from January 2022 to January 2024 were analyzed. According to the different surgical approaches, they were divided into the parapatellar approach group and the subvastus approach group. All the baseline characteristics were recorded in all subjects. Perioperative indicators The length of incision, intraoperative blood loss, operation time, hospital stay, postoperative intestinal exhaust time, and postoperative activity time were recorded for the two groups. Pain assessments were performed by the Visual Analog Scale (VAS) and McGill Pain Questionnaire (MPQ) scores. Knee joint function was evaluated by using Lysholm knee joint function score and The Western Ontario and McMaster Universities Arthritis Index (WOMAC) osteoarthritis index score, and X- rays were used to evaluate lower limb force alignment, the medial angle of the proximal tibia (MPTA) and the lateral angle of the distal femur (LDFA) were recorded. The 30-day postoperative and late (6 months) postoperative complications of all primary total knee arthroplasty were recorded. Lastly, the SF-36 questionnaire was used to evaluate health-related quality of life. Multivariate logistic regression analysis was conducted to evaluate the effect size and confidence intervals of parapatellar approach and subvastus approach on postoperative outcomes. Results The baseline characteristics of the two groups of patients were comparable ( P <0.05). The blood loss in the parapatellar group is (355.6 ± 34.6) ml, but only (343.4 ± 38.1) ml in the subvastus group, suggesting a less invasive approach for TKA surgery. The operation time is shorter in the sub vastus group compared with the parapatellar group (73.5 ± 4.9 vs 75.6 ± 5.4). Significant differences were also observed in postoperative activity time between the two groups (29.9 ± 4.5 vs 23.6 ± 4.6). Compared to 0 months (baseline), the LKS scores increased notably after treatment for 1 month, 3 months, 6 months and 12 months in the parapatellar group and subvastus group. After treatment for 6 and 12 months, the scores in the subvastus group were higher in contrast to the parapatellar group ( P <0.05). The LDFA scores also proved that the subvastus group has a higher score after 6 and 12 months of treatment compared to the parapatellar group (84.5 ±2.3 vs 86.3 ± 2.4, 85.2 ± 1.2 vs 87.4 ± 2.5, P <0.05). The VAS score and MPA score in the subvastus group decreased notably compared to the parapatellar group after 1 week, 1 month, 3 months and 6 months after surgery ( P <0.05). The total local complications in the parapatellar group and subvastus group were 28.9% vs 18.4%, the differences were significant ( P <0.05), and the total late postoperative complications in the subvastus group were significantly lower than parapatellar group (1.18% vs 2.6%, P <0.05). Significant differences between the parapatellar group and subvastus group in several aspects of the SF-36 quality of life scores system, indicating higher life quality in patients in the subvastus group. Multiple logistic regreesion analysis showed parapatellar approach was an independent risk factor for postoperative surgical related complications occurence (OR=5.93, 95% CI: 4.44-12.74), decrease LKS score (OR=0.44, 95% CI: 0.27-0.72), increase WOMAC score (OR=1.35, 95% CI: 1.11-1.64), decrease LDFA (OR=0.86, 95% CI: 0.78-0.95). Conclusion Compared with the standard parapatellar approach, the modified subvastus approach for total knee arthroplasty is beneficial for relieving early postoperative pain, allowing patients to achieve better knee function, lower local complications and higher quality of life, which is more in line with the concept of accelerated recovery after surgery.

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