Phruetthiphat Ong-Art, Mokmongkolkul Krissada, Apinyankul Rit
Department of Orthopaedics, Phramongkutklao Hospital, Bangkok, Thailand.
Faculty of Medicine, Department of Orthopaedics, Khon Kaen University, Khon Kaen, Thailand.
Arthroplast Today. 2024 Apr 24;27:101365. doi: 10.1016/j.artd.2024.101365. eCollection 2024 Jun.
Anterior skin numbness is a common complication after total knee arthroplasty (TKA) that may impact postoperative functional outcomes. This study aimed to compare skin numbness area, functional outcomes, and patient satisfaction between patients undergoing TKA with a medial parapatellar approach (medial group) and a lateral parapatellar approach (lateral group).
A prospective randomized study included 68 knees undergoing TKA via the medial parapatellar approach (n = 32) and the lateral parapatellar approach (n = 32) through the midline skin incision. Anterior skin numbness was assessed as the primary outcome using Semmes-Weinstein monofilaments at 6 postoperative timepoints (2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years). Knee range of motion, Knee Injury and Osteoarthritis Outcome Score (KOOS), and patient satisfaction scores were collected. Fifty-nine patients were retrieved at the 2-year final follow-up. Statistical analysis considered repeated outcome measurements with adjusted -values.
The lateral group had a significantly smaller area of anterior skin numbness at 2 weeks (11.2 vs 20.2 sq.cm.), 6 weeks (8.2 vs 17.2 sq.cm.), and 3 months (7.8 vs 14.4 sq.cm.) postoperatively compared to the medial group. No difference in the area of numbness was found at 6 months, 1 year, and 2 years. Although the lateral group showed significantly higher satisfaction scores ( = .027) and the KOOS symptoms subdomain ( = .018), there were no differences in knee range of motion and other components of KOOS in both groups.
Compared to the medial approach, the lateral parapatellar approach in TKA demonstrates a reduced area of early postoperative skin numbness and expedited 6-month recovery, along with marginally superior patient satisfaction scores. However, both approaches yield comparable outcomes in terms of postoperative knee motion and overall functional outcomes.
前侧皮肤麻木是全膝关节置换术（TKA）后常见的并发症，可能影响术后功能结局。本研究旨在比较采用内侧髌旁入路（内侧组）和外侧髌旁入路（外侧组）进行TKA的患者之间的皮肤麻木面积、功能结局和患者满意度。
一项前瞻性随机研究纳入了68例通过中线皮肤切口采用内侧髌旁入路（n = 32）和外侧髌旁入路（n = 32）进行TKA的膝关节。在术后6个时间点（2周、6周、3个月、6个月、1年和2年），使用Semmes-Weinstein单丝评估前侧皮肤麻木情况作为主要结局。收集膝关节活动范围、膝关节损伤和骨关节炎结局评分（KOOS）以及患者满意度评分。在2年的最终随访中找回了59例患者。统计分析考虑了采用校正值的重复结局测量。
与内侧组相比，外侧组术后2周（11.2 vs 20.2平方厘米）、6周（8.2 vs 17.2平方厘米）和3个月（7.8 vs 14.4平方厘米）时前侧皮肤麻木面积明显更小。在6个月、1年和2年时，麻木面积没有差异。尽管外侧组的满意度评分明显更高（P = 0.027）和KOOS症状子域评分更高（P = 0.018），但两组在膝关节活动范围和KOOS的其他组成部分方面没有差异。
与内侧入路相比，TKA中的外侧髌旁入路术后早期皮肤麻木面积减小，6个月恢复加快，患者满意度评分略高。然而，两种入路在术后膝关节活动和总体功能结局方面产生的结果相当。
