MEDIAN PARAPETELLAR VERSUS MIDVASTUS APPROACH ON THE OUTCOMES IN TOTAL KNEE REPLACEMENT

Background: The most common approaches used in Total Knee Replacement surgery are Midvastus, subvastus, median parapetellar, lateral patellar and trivector approach. There is uncertainty as to the best surgical approach to the knee joint for knee replacement. Median parapetellar approach is the standard of practice, but off late quadriceps sparing approaches as like subvastus and midvastus are performed. Subvastus approach has its own limitation of less joint exposure. In our clinical setup, orthopaedic surgeons perform median parapetellar and midvastus approach. The present study has compared outcome of knee function between a standard median parapetellar arthrotomy and mid vastus arthrotomy for patients undergone primary total knee arthroplasty. The post op quadriceps function depend on the type of surgical approach Materials and methods: 30 subjects were recruited who had undergone Total knee arthroplasty with Median parapetellar and Midvastus approach at Sri Ramachandra medical hospital; received standard physiotherapy care. The pre-op and post quadriceps angle were measured and the quadriceps, hamstrings isometric muscle strength and 6 minute walk test of the patients were recorded at the time of discharge and after one month of follow-up, and the data were statistically analyzed. Results: Median parapetellar and Midvastus approach were significant within the groups; with respect to quadriceps angle (QA) (p<0.05), isometric strength of quadriceps (QS) (p<0.05) and 6 minute walk test (WT) (p<0.05). On comparing between the groups at one month follow-up isometric strength of hamstrings (HS) (p<0.01) and 6 minute walk test (p<0.01) were found to be significant. Discussion: Findings show that Mid-vastus approach provides better results in terms of quadriceps angle, isometric strength of quadriceps and 6 minute walk test compared to median parapetellar approach. Conclusion: Study concludes that, the isometric strength of quadriceps and hamstrings has improved at the time of discharge and after one month of follow up (within the group). However no much significant changes seen between the groups.