PhD Scientific Days 2022

Clinical Medicine I. (Poster discussion will take place in the Aula during the Coffee Break)

Subvastus Approach Supporting Fast Track Total Knee Arthroplasty Over Medial Parapatellar Approach

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 necessary 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 of TKR.
Although several approaches exist, most of the studies compare the medial parapatellar (MP) approach to the group of minimal invasive technics, like subvastus (S), mini-subvastus, or midvastus. In our study, we aimed to compare the effects of the early postoperative rehabilitation focusing on the S, and the MP approaches.
Methods
We conducted our clinical trial at the Department of Orthopedics, Semmelweis University from January 2021 to December 2021. Our included 100 patients were separated into two different groups, the S and the MP group, with 50-50 in each group. All the patients were hospitalized for 7 days. We collected data about the pain using the Visual Analogue Scale (VAS), the range of motion (ROM), the first day of the 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 in about 14.1 units (CI 6.7-21.5) higher ROM on average on day0 than the MP. This difference between the two methods decreases at an average of 1.7-unit (0.4-3.1) pro day. The effect of the type of surgery and their interaction was significant. VAS_A (active) and VAS_R (resting) mean value change at the time, the effect of type of the surgery and the used medication protocol was significant. It means for example that the S method results in about 1.9 units (CI 0.6-1.9) lower VAS_A than the MP. While the decrease in VAS_A is about 0.6 on average pro days. It means for example that the S method results in about 2.5-unit lower rest VAS_R on average on day0 than the MP. This difference between the two methods decreases at an average of 0.2-unit per day. While the decrease in resting VAS is about 0.56 on average pro days. The medication protocol mean value changed at the time, and the effect of the surgery type was significant.
Conclusion
Using the S approach could result in a more effective early postoperative rehabilitation.