The mid-vastus approach: a compromise between the medial parapatellar approach and the minimally invasive approach in total knee arthroplasty

Abstract

Objectives The study was conducted to evaluate midvastus approach in total knee arthroplasty. Background The medial parapatellar approach, originally described by Von Langenbeck in 1879, remained as the work horse in total knee replacement surgery. The major problems in this technique are reduction of patellar blood flow, extensor mechanism imbalance, and the need for lateral retinacular release in some cases. The vastus medialis approach appeared as an alternative to the traditional medial parapatellar incision, with which to minimize the risks of extensor mechanism imbalance. When using this approach, no special instruments, as in the case of minimally invasive surgery, is needed. The same benefits could be achieved, such as proper visualization during surgery and shorter operative time. Patients and methods This is a prospective study of 29 primary knee arthroplasties performed using the midvastus approach without patellar eversion in Suez Canal University Hospital between May 2008 and June 2010. Mobile-bearing cruciate-substituting total knee prosthesis was used in all cases. Results Operative data showed no increase in the operative time with no significant increase in the blood loss. No lateral retinacular release was needed. The bone defects can be treated easily through this approach. No serious complications were encountered in patients, except in one case in which infected prosthesis was observed. Conclusion The approach is universal and can be recommended for all patients (except for revision cases and in cases of severe deformities). The results are better in this approach compared with the standard approach, with earlier return to start straight leg raising, faster pain relief, and shorter hospital stay.