[On the "subvastus" approach in surgery of the knee joint.]

The "subvastus" approach to the knee joint can be considered an alternative to the standard parapatellar approach. It respects anatomical structures to a greater extent, as the insertion of the distal part of the m. vastus medialis is not severed, it preserves better the vascular supply to the patella and makes it possible to test more accurately the movement of the patella in implanted endoprostheses. From 42 patients to whom the authors implanted a TKR using this method they selected a group of 16 patients where the implantation was made on one side using the classic approach and on the other side using the "subvastus" approach, while the same type of endoprosthesis was used. The authors investigated the motility and function of both knee joints three months after surgery, early postoperative blood losses and subjective evaluation of the operation by the patients. As regards motility and function of the joint the authors did not find a difference between the two approaches. In the group of implantations using the "subvastus" approach they found a slight reduction of blood losses (by 80 ml). Patients in the more closely investigated group evaluate subjectively the postoperative course and resulting status of the joints more favourably after the "subvastus" approach. The described approach is not more time consuming, the suture of the extensor apparatus is even easier. It is, however, not suited for patients with serious articular changes, where difficulties with eversion of the patella may be assumed and in very obese patients or very short patients and in joints after previous major operations. Key words: surgical approach, "subvastus" approach, arthroplasty of the knee joint.