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Medial midvastus approach in total knee arthroplasty does not lead to superior WOMAC score, range of motion or prosthesis survival compared to medial parapatellar approach: an analysis based on arthroplasty registry data
ESSKA Academy. Lechner R. May 11, 2018; 218086
Ricarda Lechner
Ricarda Lechner
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Abstract
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Objectives: It was the aim of the study to test whether medial midvastus (MMV) and medial parapatellar (MPP) approaches would lead to significantly different results of total knee arthroplasty (TKA) with regard to patient reported knee score outcome (hypothesis 1), range of motion short-term postoperatively (hypothesis 2), range of motion long-term postoperatively (hypothesis 3) and prosthesis survival (hypothesis 4).

Methods: A retrospective-comparative study design was applied. Patients who previously underwent primary TKA as part of the clinical routine were analyzed. Data sets were provided from the federal state's arthroplasty registry. Cases were excluded in the case of: a) surgical approaches other than MPP and MMV, b) implants other than CR implants of a certain brand, c) incomplete preoperative WOMAC data, d) incomplete postoperative WOMAC data (1 year) and e) TKA revisions.
WOMAC data was analyzed from preoperative and 1 year postoperatively (WOMAC pain, WOMAC stiffness, WOMAC function, WOMAC total) (0: best, 100: worst).
Range of motion data was collected with goniometers during clinical routine and was taken from the medical records for the following points in time: preoperative, postoperative days 4 and 10 and one year postoperative.

Results: 627 cases (407 MMV vs. 220 MPP) were available for analysis. In the MMV group the age was 70.1 ±9.1 years, 64.1% of the participants were female and in 43.7% the left side was operated. In the MPP group the age was 69.0 ±9.7 years, 57.7% of the participants were female and in 45.5% the left side was operated. None of those demographic parameters was significantly different between the groups.

In the MMV group the WOMAC total improved from 51.6 preoperatively to 20.1 at one year postoperative. In the MPP group the WOMAC total improved from 51.2 preoperatively to 21.6 one year postoperatively. One year postoperatively, there were no significant differences between groups. Neither, in WOMAC total nor in the three WOMAC subscores (Hypothesis 1).

Preoperative ROM was 109.5° in the MMV group and 108° in the MPP group (p = 0.2819). Early postoperatively, at days 4 and 10 after TKA there were also no differences between groups (p = 0.3049 and p = 0.3828, Hypothesis 2). Likewise, ROM was not significantly different between the groups one year after TKA (p = 0.3376, Hypothesis 3).

5 year prosthesis survival was not different between groups and showed 94.46% (95%CI: 90.69% to 96.73%) in the MMV group and 94.33% (95%CI: 89.96% to 96.83%) in the MPP group (p = 0.6639, Hypothesis 4).

Conclusions: There seem to be no significant differences between MPP and MMV approaches in TKA. This is true for knee scores, implant survival and both early and late range of motion. Consequently, the question of MMV or MPP should be answered by surgeon's preference / convenience.

Keywords:
total knee arthroplasty, midvastus, medial parapatellar, arthroplasty registry
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