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Comparing the Subvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty
Parin Shah1, Ravindra Singh1, Pawan Kumar Shanwal1
1Department of Orthopedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India.
Introduction:
Knee osteoarthritis (OA) is a common cause of pain and disability in the elderly, for which total knee arthroplasty (TKA) is an effective treatment. The medial parapatellar approach is widely used but may impair patellar blood supply and delay quadriceps recovery. The subvastus (SV) approach has been introduced to preserve the extensor mechanism and potentially allow faster post-operative rehabilitation. This study compares the SV and medial parapatellar approaches in primary TKA, focusing on early recovery of quadriceps function.
Objective:
This study aims to evaluate and compare the SV and medial parapatellar approaches for total knee replacement (TKR) in patients with OA at a tertiary care center, focusing on the time required for post-operative recovery of quadriceps function.
Materials And Methods:
We conducted a retrospective review of medical records from 200 patients with OA who underwent TKR at a tertiary care hospital between January 2024 and December 2025. Patients were categorized into two groups: Group A underwent TKR using the SV approach, while Group B received TKR through the medial parapatellar approach. Pre-operative data, including quadriceps strength, body mass index, and baseline demographic characteristics, were collected from initial workup notes. Demographic data of all the patients were described in Table. Starting from the 1st post-operative day, the time to the first unassisted straight leg raise was recorded as the primary measure of quadriceps function. The collected data were then analyzed to assess post-operative quadriceps recovery.
Results:
The SV approach was associated with faster recovery of quadriceps function compared to the medial parapatellar approach. Patients in their sixties experienced the most significant improvement. In addition, pre-operative quadriceps strength was found to play a key role in post-operative muscle recovery.
Conclusion:
The SV approach in TKA promotes faster early recovery, including quicker quadriceps function, less pain, earlier range of motion, and shorter hospital stays compared to the medial parapatellar approach. Long-term functional outcomes are similar between the two techniques. Although technically more demanding, the SV approach is a safe and effective option that enhances early rehabilitation.
