Original Article

Is subvastus approach better in bilateral TKA? Comparison of early functional outcomes of subvastus and medial para-patellar approach in Simultaneous Bilateral Total Knee Arthroplasty (SBTKA)

Chetan Sood¹, Thulasidharan Vengappally Panichedath², Emy Jo Titus³

1. Army Hospital (Research & Referral), New Delhi, India
2. Base Hospital Delhi Cantt, New Delhi, India
3. Indian Spinal Injuries Centre, New Delhi, India

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Keywords: KSS, Medial para-patellar, Subvastus, TKA, PROM

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Abstract

Objectives: Medial para-patellar is common approach for TKA; Subvastus approach is technically demanding and spares the quadriceps mechanism. Does the subvastus approach significantly improve outcomes compared to medial para-patellar approach in simultaneous bilateral total knee arthroplasty (SBTKA)? Methods: The study conducted on 100 patients between Jan 2018 to June 2019 matched in base demographics and clinical parameters divided in two equal groups; medial para-patellar approach and subvastus approach. VAS and PROM assessed in early post-operative period. Functional outcomes assessed using WOMAC scores and KSS postoperatively up to 01 year. Results: VAS at 3^rd week was significantly higher in para-patellar group. At 3 weeks, 6 weeks and 3 months follow-up WOMAC score was higher and KSS was lower in para-patellar group. At 06 months and 01 year both WOMAC and KSS scores were similar. Measured functional outcomes were consistently better in subvastus group. Conclusion: Subvastus approach had less post-operative pain, faster recovery and better functional outcomes after surgery as compared to medial para-patellar approach in early post-operative period. There was no difference in outcomes at 01 year. The complication rates, transfusion rate, hospital stay, requirement of physiotherapy and rehabilitation was similar for both groups. We conclude the subvastus approach significantly improves early outcomes in SBTKA cases.

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