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

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

• 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
• 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
• 3 Insall J. A midline approach to the knee. J Bone Joint Surg Am 1971; 53 (08) 1584-1586
• 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
• 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
• 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
• 7 Engh GA, Holt BT, Parks NL. A midvastus muscle-splitting approach for total knee arthroplasty. J Arthroplasty 1997; 12 (03) 322-331
• 8 Engh GA, Parks NL. Surgical technique of the midvastus arthrotomy. Clin Orthop Relat Res 1998; (351) 270-274
• 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
• 10 Dalury DF, Jiranek WA. A comparison of the midvastus and paramedian approaches for total knee arthroplasty. J Arthroplasty 1999; 14 (01) 33-37
• 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
• 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
• 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
• 14 Kendall FP, Mccreary EK, Provance PG. Músculos: prova e funções com postura e dor. 4a. ed.. São Paulo: Manole; 1995
• 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
• 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
• 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
• 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
• 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
• 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