Advantage of medial pivot prosthesis in total knee arthroplasty via medial subvastus approach

doi:10.12307/2022.751

Abstract

Abstract: BACKGROUND: The most commonly used approach for total knee arthroplasty is the medial parapatellar approach, but due to its damage to the quadriceps tendon, it may lead to the weakening of the extensor device in the later stage, thus affecting the long-term functional recovery of patients.
OBJECTIVE: To evaluate the advantage of total knee arthroplasty with medial pivot prosthesis through medial subvastus approach.
METHODS: Patients with unilateral knee osteoarthritis who underwent total knee arthroplasty with medial pivot prosthesis from August 2018 to October 2019 were enrolled in this study. Of them, 26 patients received medial subvastus approach and 27 patients received medial parapatellar approach. There were no significant differences in age, sex distribution, body mass index, preoperative hemoglobin, visual analogous scale pain score, knee joint score of Hospital for Special Surgery, and knee range of motion between the two groups (P > 0.05). The operative incision length, operative time, the first postoperative straight leg raising time, the first postoperative activity time out of bed and the postoperative hospitalization time were compared and analyzed between the two groups. Postoperative visual analogous scale pain score, knee Hospital for Special Surgery score, and range of motion of the knee joint were evaluated in both groups.
RESULTS AND CONCLUSION: (1) The mean incision length, the first postoperative straight leg elevation time, the first postoperative movement time, and the postoperative hospitalization time in the medial subvastus approach group were significantly shorter than those in the medial parapellar approach group (P <
0.05). There was no significant difference in the operative time between the two groups (P > 0.05). (2) At 2 days after surgery, the visual analogous scale pain score in the medial subvastus approach group was significantly lower than that in the medial parapatellar approach group (P < 0.001). At 1 month after operation, there was no significant difference in visual analogous scale pain scores between the two groups (P = 0.474). (3) The knee Hospital for Special Surgery score of patients in the medial subvastus approach group was significantly higher than that in the medial parapellar approach group at 1 and 3 months after surgery (P < 0.001). At 1 year after surgery, there was no significant difference in knee Hospital for Special Surgery score between the two groups (P=0.656). (4) At 1 month after surgery, the range of motion of knee joint in the medial subvastus approach group was significantly higher than that in the medial parapatellar approach group (P < 0.001). At 3 months and 1 year after surgery, there was no significant difference in the range of motion of knee joint between the two groups (P=0.298, P=0.999). (5) The use of medial subvastus approach for total knee arthroplasty does not damage the medial vastus tendon, and the extensor device is retained, which is convenient for the installation of medial pivot prosthesis and intraoperative evaluation of medial pivot movement. It can significantly improve the pain and swelling of the limb after operation and effectively promote the early functional exercise.

Key words: total knee arthroplasty, medial pivot knee joint prosthesis, medial subvastus approach, extensor device

CLC Number:

Wei Bo, Yao Qingqiang, Tang Cheng, Li Xuxiang, Xu Yan, Wang Liming. Advantage of medial pivot prosthesis in total knee arthroplasty via medial subvastus approach[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(4): 552-557.

Figures/Tables 6

References

[1] 雷光华,王坤正.骨关节炎诊疗指南(2018年版).中华骨科杂志, 2018,38(12):716-717.
[2] SCAPINELLI R. Blood supply of the human patella: its relation to ischaemic necrosis after fracture.J Bone Joint Surg Br. 1967;49(3):563-570.
[3] PAGNANO MW. Patellar tendon and quadriceps tendon tears after total knee arthroplasty. J Knee Surg. 2003;16(4):242-247.
[4] HOFMANN AA, PLASTER RL, MURDOCK LE. Subvastus (Southern) approach for primary total knee arthroplasty. Clin Orthop Relat Res. 1991;269:70-77.
[5] LI Z, CHENG W, SUN L, et al. Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study. Int Orthop. 2018;42(3):543-549.
[6] 姚运峰,康鹏德,薛晨曦,等.经股内侧肌下微创入路与传统入路行人工全膝关节置换术的前瞻性随机对照研究[J].中国修复重建外科杂志,2018,32(2):162-168.
[7] MACHERAS GA, GALANAKOS SP, LEPETSOS P, et al. A long term clinical outcome of the Medial Pivot Knee Arthroplasty System. Knee. 2017;24(2):447-453.
[8] SAMY DA, WOLFSTADT JI, VAIDEE I, et al. A retrospective comparison of a medial pivot and posterior-stabilized total knee arthroplasty with respect to patient- reported and radiographic outcomes. J Arthroplasty. 2018;33(5):1379-1383.
[9] CHAREANCHOLVANICH K, PORNRATTANAMANEEWONG C. Does the length of incision in the quadriceps affect the recovery of strength after total knee replacement? a prospective randomised clinical trial. Bone Joint J. 2014;96(7):902-906.
[10] GRACE JN, RAND JA. Patellar instability after total knee arthroplasty. Clin Orthop Relat Res. 1988(237):184-189.
[11] BERSTOCK JR, MURRAY JR, WHITEHOUSE MR, et al. Medial subvastus versus the medial parapatellar approach for total knee replacement: a systematic review and meta-analysis of randomized controlled trials. EFORT Open Rev. 2018;3(3):78-84.
[12] MATSUEDA M, GUSTILO RB. Subvastus and medial parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res. 2000;371: 161-168.
[13] DOJODE D, DIXIT UR, REDDY MGS, et al. Medial parapatellar versus subvastus approach in total knee arthroplasty. Int J Orthop Sci. 2018; 4(4):40-45.
[14] KHAN MNH, ABBAS K, FARAZ A, et al. Total knee replacement: A comparison of the subvastus and medial parapatellar approaches. Ann Med Surg (Lond). 2021;68:102670.
[15] WU Y, ZENG Y, BAO X, et al.Comparison of mini-subvastus approach versus medial parapatellar approach in primary total knee arthroplasty. Int J Surg. 2018;57:15-21.
[16] MIGLIORINI F, ARETINI P, DRIESSEN A, et al. Better outcomes after mini-subvastus approach for primary total knee arthroplasty: a Bayesian network meta-analysis. Eur J Orthop Surg Traumatol. 2020;30(6):979-992.
[17] BOUCHÉ PA, CORSIA S, NIZARD R, et al. Comparative efficacy of the different surgical approaches in total knee arthroplasty: A systematic-review and network meta-analysis. J Arthroplasty. 2021;36(3):1187-1194.e1.
[18] MADADI F, MADADI F, OSIAS E, et al. Comparison of Effects of Medial Parapatellar and Subvastus Bilateral Simultaneous Approaches in Total Knee Arthroplasty. J Arthroscopy Joint Surg. 2021. doi: 10.1016/j.jajs.2021.06.001
[19] LANTING BA, LEGAULT JA, JOHNSON MI, et al. Lateral subvastus approach: A cadaveric examination of its potential for total knee arthroplasty. Knee. 2020;27(4):1271-1278.
[20] SIDHU SP, MOSLEMIAN A, YAMOMO G, et al. Lateral subvastus lateralis versus medial parapatellar approach for total knee arthroplasty: A cadaveric biomechanical study. Knee. 2020;27(6):1735-1745.
[21] Noble PC, Gordon MJ, Weiss JM, et al. Does total knee replacement restore normal knee function?. Clin Orthop Relat Res. 2005;431:157-165.
[22] Sabatini L, Risitano S, Parisi G, et al. Medial pivot in total knee arthroplasty: literature review and our first experience. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544117751431.
[23] 李旭祥,张惠康,魏波,等.基于MRI和三维CT个性化截骨导板在内轴型膝关节假体置换中的应用[J].中国组织工程研究,2020, 24(30):4835.
[24] Sheth NP, Husain A, Nelson CL. Surgical techniques for total knee arthroplasty: measured resection, gap balancing, and hybrid. J Am Acad Orthop Surg. 2017;25(7):499-508.