Joint Replacement Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India.
J Knee Surg. 2021 May;34(6):635-643. doi: 10.1055/s-0039-1700496. Epub 2019 Nov 4.
Subvastus approach preserves the quadriceps mechanism and may lead to improved early functional outcomes as compared with a parapatellar approach in primary knee arthroplasty. We performed a prospective randomized study to test the hypothesis if subvastus approach improves patient- and physician-reported outcomes in navigated sequential bilateral knee arthroplasty when compared with the standard parapatellar approach. A total of 93 patients were allotted in each group after power analysis and randomization done by computer-generated sequence: group S by subvastus approach and control group P by parapatellar approach. The patient's ability to walk without an aid, range of motion, blood loss, tourniquet time, complications, Knee Society Score (KSS), Knee Society Functional Score (KSFS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), High Flexion Knee Score (HFKS), and visual analog scale (VAS) for pain were recorded preoperatively and postoperatively at 2 and 6 weeks and 3, 6, and 12 months. Final follow-up was done at 2 years. There was no statistical difference in the patient's ability to achieve a straight leg raise ( = 0.88), walk without an aid ( = 0.25), leaving pain medication ( = 0.48), and mean duration of hospital stay ( = 0.58) between both groups. There was no difference in KSS, FS, KOOS, WOMAC, HFKS, and VAS at 2 weeks and later follow-ups. There was no significant difference in range of motion or lateral retinacular release in both groups. Blood loss was significantly less in group S ( < 0.05), but there was a higher rate of proximal wound dehiscence and delayed healing in subvastus group ( = 0.03). Subvastus approach does not improve patient- and physician-reported outcome measures except blood loss in computer-navigated sequential bilateral knee arthroplasty and has an increased incidence of wound healing problems. The Level of evidence for the study is I.
股外侧肌下入路保留了股四头肌机制，与髌旁入路相比，可能在初次全膝关节置换中导致早期功能结果改善。我们进行了一项前瞻性随机研究，以检验以下假设：与标准髌旁入路相比，股外侧肌下入路是否在计算机导航序贯双侧全膝关节置换术中改善患者和医生报告的结果。在进行了功率分析和计算机生成序列的随机分组后，每组 93 名患者被分配到股外侧肌下入路组（S 组）和髌旁入路组（P 组）：S 组采用股外侧肌下入路，P 组采用髌旁入路。记录患者术前和术后 2 周和 6 周以及 3 个月、6 个月和 12 个月的无辅助行走能力、关节活动度、失血量、止血带时间、并发症、膝关节协会评分（KSS）、膝关节协会功能评分（KSFS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、膝关节损伤和骨关节炎结果评分（KOOS）、高屈曲膝关节评分（HFKS）和疼痛视觉模拟量表（VAS）。最终随访时间为 2 年。两组患者直腿抬高能力（ = 0.88）、无辅助行走能力（ = 0.25）、停止使用止痛药（ = 0.48）和平均住院时间（ = 0.58）差异无统计学意义。两组在 2 周及以后的随访中，KSS、FS、KOOS、WOMAC、HFKS 和 VAS 均无差异。两组的关节活动度或外侧支持带松解均无显著差异。S 组失血量明显减少（ < 0.05），但股外侧肌下入路组有更高的近端伤口裂开和愈合延迟发生率（ = 0.03）。除了计算机导航序贯双侧全膝关节置换术中的失血量外，股外侧肌下入路并不能改善患者和医生报告的结果测量指标，而且增加了伤口愈合问题的发生率。本研究的证据水平为 I 级。
