Midvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

1. Department of Orthopaedics Trauma and Hand Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China;2. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Total knee arthroplasty; Midvastus approach; Medial parapatellar approach; Systematic review

DOI：

10.7507/1672-2531.20100453

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Objective 　To evaluate the efficacy and safety of the midvastus approach in total knee arthroplasty.
Methods 　We searched The Cochrane Library, EMBASE, PubMed, and CBM to identify clinical controlled trials comparing the midvastus approach with the medial parapatellar approach in total knee arthroplasty. The quality of the included studies was critically assessed and the data analyses were performed by the Cochrane Collaboration’s RevMan 5.0.
Results 　Eight studies were included, involving 4 randomized controlled trials (RCTs), 2 quasi-RCTs and 2 non-RCTs. Meta-analyses showed that rate of lateral retinacular release (RR=0.75, 95%CI 0.52 to 1.08, P=0.12), range of motion at 6 week postoperation (MD=2.65, 95%CI –1.20 to 6.50, P=0.18), operation time (MD=1.04, 95%CI –3.50 to 5.58), and adverse events postoperation (OR=1.04, 95%CI 0.43 to 2.52, P=0.94) were similar between the midvastus approach and the medial parapatellar approach in total knee arthroplasty. One study showed that there was no significant difference in blood loss interoperation between the two approaches, and two showed that the midvastus approach had less blood loss interoperation than the medial parapatellar approach. There was no statistical analysis about the blood loss interoperation in one study. For the time of straight leg raise, there was no significant difference in two studies. But in one study, it showed that patients needed longer time for straight leg raise.
Conclusion 　Based on the current evidence, the midvastus approach for total knee arthroplasty is as safe and effective as the medial parapatellar approach, but blood loss interoperation and time of straight leg raise are not decided. Due to the poor quality of the included trials, more high-quality RCTs are needed.

Citation： XU Yinglong,ZHAO Jinmin,LI Shuzhen,DING Xiaofei,WU Taixiang. Midvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(5): 585-591. doi: 10.7507/1672-2531.20100453 Copy

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2.	Heck DA, Robinson RL, Partridage CM, et al. Patient Outcomes after Knee Replacement. Clin Orthop Relat Res, 1998, 356: 93-l10．.
3.	Boyd AD, Ewald FC, Thomas WH, et al. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am, 1993, 75: 674-681.
4.	Stuart MJ, Larson JE, Morrey BF. Reoperation after condylar revision total knee arthroplasty. Clin Orthop Relat Res, 1993, 286: 168-173.
5.	Aaron GR, Joshua JJ, Khaled GS, et al. The patella in revision total knee arthroplasty. J Bone Joint Surg Am, 2003, 85: 63-69.
6.	Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty, 1987, 2: 135-140.
7.	Hofmann AA, Plaster RL, Murdock LE. Subvastus (Southern) approach for primary total knee arthroplasty. Clin Orthop, 1991, 269: 70-77.
8.	Engh GA, Holt BT, Parks NL. A midvastus muscle-splitting approach for total knee arthroplasty. J Arthroplasty, 1997, 12: 322-331.
9.	Weinrauch P, Myers N, Wilkinson M, et al. Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation. The Journal of Orthopaedic Surgery (Hong Kong), 2006, 14(1): 47-52.
10.	Bassarir K, Erdemli B, Tuccar E, et al. Safe zone for the descending genicular artery in the midvastus approach to the knee. Clin Orthop Relat Res, 2006, 451: 96-100.
11.	Dalury DF, Jiranek WA. A comparison of the midvastus and paramedian approaches for total knee arthroplasty. J Arthroplasty, 1999, 14(1): 33-37.
12.	Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
13.	吴泰相, 刘关键. 隐蔽分组（分配隐藏）和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 203-207.
14.	Bäthis H, Perlick L, Blum C, et al. Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7): 545-550.
15.	Fu PL, Li XH, Wu YL, et al. Comparison of midvastus and standard medial parapatellar approaches in total knee arthroplasty. Journal of Clinical Rehabilitative Tissue Engineering Research, 2008, 12(9): 1793-1796.
16.	Keating EM, Faris PM, et al. Comparison of the midvastus musclesplitting approach with the median parapatellar approach in total knee arthroplasty. J Arthroplasty, 1999, 14(1): 29-32.
17.	Kelly MJ, Rumi MN, Kothari M, et al. Comparison of the Vastus- Splitting and Median Parapatellar Approaches for Primary Total Knee Arthroplasty: A Prospective, Randomized Study. J Bone Joint Surg Am, 2006, 88(4): 715-720.
18.	Walter F, Haynes MB, Markel DC, et al. A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty, 2007, 22(4): 509-514.
19.	White RE, Allman JK, Trauger JA, et al. Clinical comparison of the midvastus and medial parapatellar surgical approaches. Clin Orthop Relat Res, 1999, (367): 117-122.
20.	McMahon MS, Scudefi GR, Glashow JL, et al. Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/ or lateral retinacular release in total knee arthroplasty. Clin Orthop, 1990, (260): 10-l6.
21.	覃承珂, 裴国献, 罗吉伟, 等. 全膝关节置换术中外侧支持带松解的指征. 中华创伤骨科杂志, 2006, 8(4): 396-397.
22.	Maestro A, Suarez MA, Rodriguez L, et al. The midvastus surgical approach in total knee arthroplasty. Int Orthop, 2000, 24(2): 104-107.

1. Carol JD, Christine AL, Verita CB, et al. 2006 National Hospital Discharge Survey. National Health Statistics Report, 2008, July 30, Number 5.
2. Heck DA, Robinson RL, Partridage CM, et al. Patient Outcomes after Knee Replacement. Clin Orthop Relat Res, 1998, 356: 93-l10．.
3. Boyd AD, Ewald FC, Thomas WH, et al. Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am, 1993, 75: 674-681.
4. Stuart MJ, Larson JE, Morrey BF. Reoperation after condylar revision total knee arthroplasty. Clin Orthop Relat Res, 1993, 286: 168-173.
5. Aaron GR, Joshua JJ, Khaled GS, et al. The patella in revision total knee arthroplasty. J Bone Joint Surg Am, 2003, 85: 63-69.
6. Lynch AF, Rorabeck CH, Bourne RB. Extensor mechanism complications following total knee arthroplasty, 1987, 2: 135-140.
7. Hofmann AA, Plaster RL, Murdock LE. Subvastus (Southern) approach for primary total knee arthroplasty. Clin Orthop, 1991, 269: 70-77.
8. Engh GA, Holt BT, Parks NL. A midvastus muscle-splitting approach for total knee arthroplasty. J Arthroplasty, 1997, 12: 322-331.
9. Weinrauch P, Myers N, Wilkinson M, et al. Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation. The Journal of Orthopaedic Surgery (Hong Kong), 2006, 14(1): 47-52.
10. Bassarir K, Erdemli B, Tuccar E, et al. Safe zone for the descending genicular artery in the midvastus approach to the knee. Clin Orthop Relat Res, 2006, 451: 96-100.
11. Dalury DF, Jiranek WA. A comparison of the midvastus and paramedian approaches for total knee arthroplasty. J Arthroplasty, 1999, 14(1): 33-37.
12. Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
13. 吴泰相, 刘关键. 隐蔽分组（分配隐藏）和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 203-207.
14. Bäthis H, Perlick L, Blum C, et al. Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation. Knee Surg Sports Traumatol Arthrosc, 2005, 13(7): 545-550.
15. Fu PL, Li XH, Wu YL, et al. Comparison of midvastus and standard medial parapatellar approaches in total knee arthroplasty. Journal of Clinical Rehabilitative Tissue Engineering Research, 2008, 12(9): 1793-1796.
16. Keating EM, Faris PM, et al. Comparison of the midvastus musclesplitting approach with the median parapatellar approach in total knee arthroplasty. J Arthroplasty, 1999, 14(1): 29-32.
17. Kelly MJ, Rumi MN, Kothari M, et al. Comparison of the Vastus- Splitting and Median Parapatellar Approaches for Primary Total Knee Arthroplasty: A Prospective, Randomized Study. J Bone Joint Surg Am, 2006, 88(4): 715-720.
18. Walter F, Haynes MB, Markel DC, et al. A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty, 2007, 22(4): 509-514.
19. White RE, Allman JK, Trauger JA, et al. Clinical comparison of the midvastus and medial parapatellar surgical approaches. Clin Orthop Relat Res, 1999, (367): 117-122.
20. McMahon MS, Scudefi GR, Glashow JL, et al. Scintigraphic determination of patellar viability after excision of infrapatellar fat pad and/ or lateral retinacular release in total knee arthroplasty. Clin Orthop, 1990, (260): 10-l6.
21. 覃承珂, 裴国献, 罗吉伟, 等. 全膝关节置换术中外侧支持带松解的指征. 中华创伤骨科杂志, 2006, 8(4): 396-397.
22. Maestro A, Suarez MA, Rodriguez L, et al. The midvastus surgical approach in total knee arthroplasty. Int Orthop, 2000, 24(2): 104-107.

Chinese Journal of Evidence-Based Medicine

Midvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Systematic Review

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