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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(01): s00441800945
DOI: 10.1055/s-0044-1800945
Artigo Original

A Comparative Study of the Medial Parapatellar and Midvastus Surgical Approaches for Total Knee Arthroplasty

Article in several languages: português | English
Robson Rocha da Silva 
1   Departamento de Cirurgia, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
2   Santa Casa de Misericórdia da Bahia-Hospital Santa Izabel, Salvador, BA, Brasil.
,
Marcos Almeida Matos 
1   Departamento de Cirurgia, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
2   Santa Casa de Misericórdia da Bahia-Hospital Santa Izabel, Salvador, BA, Brasil.
,
Danilo Alves Badaró 
2   Santa Casa de Misericórdia da Bahia-Hospital Santa Izabel, Salvador, BA, Brasil.
,
Pablo Barreto Prata 
3   Departamento de Cirurgia, Hospital Universitário de Lagarto, Lagarto, SE, Brasil.
,
Diego Ariel de Lima 
4   Departamento de Ciências da Saúde, Universidade Federal Rural do Semi-Árido (UFERSA), Mossoró, RN, Brasil.
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Abstract

Objective To compare the postoperative recovery outcomes of total knee arthroplasty (TKA) between the medial parapatellar (MP) and midvastus (MV) surgical approaches, focusing on quadriceps strength, knee motion range, and pain.

Methods This retrospective study included 82 patients with degenerative knee arthropathy who underwent primary TKA. Patients were divided into two groups: one underwent MP and the other MV. Data were collected on quadriceps strength, knee flexion and extension, pain using the visual analog scale (VAS), and the ability to perform functional tasks like walking and stair climbing. Outcomes were assessed at multiple postoperative intervals.

Results Both groups showed improvements in all measured parameters from baseline to the last follow-up, with no significant differences between them in terms of pain and the ability to walk and climb stairs. However, the MV group exhibited statistically significant greater quadriceps strength at the final follow-up.

Conclusion While both surgical approaches provided similar overall recovery outcomes, MV led to greater improvements in quadriceps strength and knee extension, suggesting a potentially quicker functional recovery in the early postoperative period.

Keywords

arthroplasty, replacement, knee - knee - quadriceps muscle - range of motion, articular

Financial Support

The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.


Work carried out at the Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brazil.




Publication History

Received: 13 June 2024

Accepted: 14 October 2024

Article published online:
04 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Robson Rocha da Silva, Marcos Almeida Matos, Danilo Alves Badaró, Pablo Barreto Prata, Diego Ariel de Lima. Estudo comparativo das abordagens cirúrgicas parapatelar medial e midvasto para artroplastia total do joelho. Rev Bras Ortop (Sao Paulo) 2025; 60: s00441800945.
DOI: 10.1055/s-0044-1800945
 

  • Referências

  • 1 de Bem AAM, Gomes JLE, Marczyk JRS. Abordagens cirúrgicas para artroplastia primária total de joelho. Rev Bras Ortop 2003; 38 (11/12): 635-644
    Search in Google Scholar
  • 2 St Jeor JD, Waterman BR, Wolf M. Medial Surgical Approaches. In: Sherman SL, Chahla J, Rodeo AS, LaPrade R. Knee Arthroscopy and Knee Preservation Surgery. Cham: Springer International Publishing; 2023: 1-16
    Search in Google Scholar
  • 3 Insall J. A midline approach to the knee. J Bone Joint Surg Am 1971; 53 (08) 1584-1586
    CrossrefPubMedSearch in Google Scholar
  • 4 Laskin RS, Beksac B, Phongjunakorn A. et al. Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res 2004; (428) 74-81
    CrossrefPubMedSearch in Google Scholar
  • 5 Haas SB, Manitta MA, Burdick P. Minimally invasive total knee arthroplasty: the mini midvastus approach. Clin Orthop Relat Res 2006; 452 (452) 112-116
    CrossrefPubMedSearch in Google Scholar
  • 6 Kelly MJ, Rumi MN, Kothari M. et al. Comparison of the vastus-splitting and median parapatellar approaches for primary total knee arthroplasty: a prospective, randomized study. J Bone Joint Surg Am 2006; 88 (04) 715-720
    PubMedSearch in Google Scholar
  • 7 Engh GA, Holt BT, Parks NL. A midvastus muscle-splitting approach for total knee arthroplasty. J Arthroplasty 1997; 12 (03) 322-331
    CrossrefPubMedSearch in Google Scholar
  • 8 Engh GA, Parks NL. Surgical technique of the midvastus arthrotomy. Clin Orthop Relat Res 1998; (351) 270-274
    CrossrefPubMedSearch in Google Scholar
  • 9 Maestro A, Suarez MA, Rodriguez L, Guerra C, Murcia A. The midvastus surgical approach in total knee arthroplasty. Int Orthop 2000; 24 (02) 104-107
    CrossrefPubMedSearch in Google Scholar
  • 10 Dalury DF, Jiranek WA. A comparison of the midvastus and paramedian approaches for total knee arthroplasty. J Arthroplasty 1999; 14 (01) 33-37
    CrossrefPubMedSearch in Google Scholar
  • 11 Bäthis H, Perlick L, Blum C, Lüring C, Perlick C, Grifka J. Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc 2005; 13 (07) 545-550
    CrossrefPubMedSearch in Google Scholar
  • 12 Nestor BJ, Toulson CE, Backus SI, Lyman SL, Foote KL, Windsor RE. Mini-midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty. J Arthroplasty 2010; 25 (6, Suppl) 5-11 , 11.e1
    CrossrefPubMedSearch in Google Scholar
  • 13 Heekin RD, Fokin AA. Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium. J Arthroplasty 2014; 29 (02) 339-342
    CrossrefPubMedSearch in Google Scholar
  • 14 Kendall FP, Mccreary EK, Provance PG. Músculos: prova e funções com postura e dor. 4a. ed.. São Paulo: Manole; 1995
    Search in Google Scholar
  • 15 Parentis MA, Rumi MN, Deol GS, Kothari M, Parrish WM, Pellegrini Jr VD. A comparison of the vastus splitting and median parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res 1999; (367) 107-116
    PubMedSearch in Google Scholar
  • 16 White Jr RE, Allman JK, Trauger JA, Dales BH. Clinical comparison of the midvastus and medial parapatellar surgical approaches. Clin Orthop Relat Res 1999; (367) 117-122
    PubMedSearch in Google Scholar
  • 17 Nutton RW, Wade FA, Coutts FJ, van der Linden ML. Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches. Arthritis (Egypt) 2014; 2014: 173857
    Search in Google Scholar
  • 18 Liu HW, Gu WD, Xu NW, Sun JY. Surgical approaches in total knee arthroplasty: a meta-analysis comparing the midvastus and subvastus to the medial peripatellar approach. J Arthroplasty 2014; 29 (12) 2298-2304
    CrossrefPubMedSearch in Google Scholar
  • 19 Alcelik I, Sukeik M, Pollock R, Misra A, Naguib A, Haddad FS. Comparing the mid-vastus and medial parapatellar approaches in total knee arthroplasty: a meta-analysis of short term outcomes. Knee 2012; 19 (04) 229-236
    CrossrefPubMedSearch in Google Scholar
  • 20 Aslam MA, Sabir AB, Tiwari V, Abbas S, Tiwari A, Singh P. Approach to Total Knee Replacement: A Randomized Double Blind Study between Medial Parapatellar and Midvastus Approach in the Early Postoperative Period in Asian Population. J Knee Surg 2017; 30 (08) 793-797
    Thieme ConnectPubMedSearch in Google Scholar