PhD Scientific Days 2021

CL_VII_L: Clinical Medicine VII. Lectures

Comparison of the Effect of Subvastus versus Medial Parapatellar Approach in the Early Postoperative Rehabilitation

Bence Gusztáv Stubnya, MD, Dpt. of Orthopedics, Semmelweis University, Budapest
Zoltán Bejek, MD, PhD, Dpt. of Orthopedics, Semmelweis University, Budapest

Text of the abstract

Introduction
Total knee arthroplasty replacement (TKR) has become one of the most successful interventions in orthopedic surgery. The estimated growing numbers of predicted operations could be found, based on the results written in the papers and our clinical experience there is no question about the fact of growth, only about its rate. This is supported by an increase in the incidence of osteoarthritis, which is the most common indication for (TKR).
Although several approaches exist, most of the studies comparing the medial parapatellar approach to the group of minimal invasive technics, like subvastus, mini-subvastus, or midvastus. In our study we aimed to compare the effects of the early postoperative rehabilitation focusing on the subvastus (S), and the medial parapatellar (MP) approaches.
Methods
We conducted our clinical trial at the Department of Orthopedics, Semmelweis University, Hungary from January 2020 to December 2020. Our included 100 patients were separated into two different groups, the (S) and the (MP) group, 50-50 in each group. All the patients were hospitalized for 7 days. We collected data about the pain using Visual Analogue Scale (VAS), about the range of motion (ROM), the first day of capability of leg raising and the first day of reaching the 90-degree ROM and we measured the analgesic drug need also.
Results
The S method results about 14.1 unit (CI 6.7-21.5) higher ROM at average in day0, then the MP. This difference between the two methods decreases at average 1.7-unit (0.4-3.1) pro days. The effect of type of the surgery and their interaction was significant. VAS_A (active) and VAS_R (resting) mean value change at time, the effect of type of the surgery and the used medication protocol was significant. It means for example that the S method results about 1.9 unit (CI 0.6-1.9) lower VAS_A then the MP. While the decrease in VAS_A is about 0.6 at average pro days. It means for example that the S method results about 2.5-unit lower rest VAS_R at average in day0, than the MP. This difference between the two methods decreases at average 0.2-unit pro days. While the decrease in resting VAS is about 0.56 at average pro days. The medicaton protocol mean value change at time, the effect of type of the surgery was significant.
Conclusion
Using the extensor sparing S approach could result a more effective early postoperative rehabilitation.

University and Doctoral School

Semmelweis University, Károly Rácz Doctoral School of Clinical Medicine