Comparison of Surgical Approach in Total Knee Arthroplasty: Midvastus and Medial Parapatellar Approaches

ABSTRACT

PURPOSE: In the incidence of lateral retinacular release, patellar tracking and clinical results were analyzed according to the surgical approach of total knee arthroplasty. MATERIALS AND METHODS: 286 osteoarthritic knees (228 patients) who had undergone patellar non-resurfaced total knee arthroplasty were analyzed and divided into two groups. Group I was 171 cases with midvastus approach, and group II was 115 cases with medial parapatellar approach. On the basis of patellar subluxation degree with no thumb test, we were deciding on whether the lateral retinacular release was needed or not. We radiologically evaluated patellar tracking, and clinically evaluated the range of knee motion, flexion contracture, and anterior knee pain. RESULTS: The lateral retinacular release was performed in 6 cases(3.5%) from group I, and 18 cases(15.7%) from group II (p=0.001). Patellar maltracking was observed in 26 cases, which were 14 cases(8.2%) from group I and 12 cases(10.4%) from group II (p=0.517). On the other hand, patellar maltracking was found in only 2 cases(8.3%) from retinaculum released group, and in 24 cases(9.2%) from retinaculum non-released group (p=0.623). Surgical approach and lateral retinacular release had no influence on clinical results. CONCLUSION: Midvastus approach could reduce the need for lateral retinacular release, but it had no influence on patellar maltracking and clinical results.