J Arthroplasty. 2023 Jun 2:S0883-5403(23)00568-5. doi: 10.1016/j.arth.2023.05.043. Online ahead of print.
ABSTRACT
OBJECTIVE: The purpose of this study was to compare the postoperative outcomes over a period of 3 years in patients who underwent bilateral total knee arthroplasty (TKA) using mid-vastus versus medial parapatellar approaches.
MATERIAL AND METHODS: In this retrospective study, two propensity-matched cohorts of patients who underwent simultaneous bilateral TKA via midvastus (MV, n=100) and medial parapatellar (MPP, n=100) approaches from January 2017 to December 2018 were compared. Surgical parameters compared were surgery time and the incidence of lateral retinacular release (LRR). Clinical parameters including the visual analog score (VAS) for pain, time for straight leg raise (SLR), range of motion (ROM), the Knee Society Score (KSS), and the Feller patellar score (FPS) were assessed in the early postoperative, and follow-up periods up to 3 years. Radiographs were evaluated for alignment, patellar tilt, and displacement.
RESULTS: LRR was performed on 17 knees (8.5%) in the MPP group and 4 knees (2%) in the MV group which was significant (P=0.03). The time to SLR was significantly lower in the MV group. There was no statistically significant difference in the length of hospital stay between the groups. The VAS, ROM, and KSS were better in the MV group within 1 month (P <0.05), but no significant differences were found later. Patellar scores, rate of patellofemoral complications, radiographic patellar tilt, and displacements were similar at all follow-up periods. The higher LRR needed in the MPP approach did not compromise the outcome scores or complication rate.
CONCLUSION: In our study, the MV approach had faster SLR, less LRR, and better pain and function scores in the first few weeks after TKA. However, its effect on different patient outcomes has not been sustained at 1 month and further follow-up points. The approach and LRR did not affect the patellar scores and patellar tracking. We recommend that surgeons use the surgical approach with which they are most familiar.
PMID:37271236 | DOI:10.1016/j.arth.2023.05.043
