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The lateral subvastus approach for total knee arthroplasty: shorter recovery time

Published in N°272 - March 2018
Article viewed 23 times

The lateral subvastus approach for total knee arthroplasty: shorter recovery time

By Y. Vanderschelden (1) – K. Mahalingam (2) in category TECHNIQUE
(1). Saint Malo, France / (2). Cork, Irlande

Thus far, minimally invasive surgery for total knee arthroplasty has aimed to reduce the length of the skin incision and to minimize trauma to the quadriceps muscle. It is defined by adoption of a medial mid- or subvastus approach route.

 

Thus far, minimally invasive surgery for total knee arthroplasty has aimed to reduce the length of the skin incision and to minimize trauma to the quadriceps muscle. It is defined by adoption of a medial mid- or subvastus approach route. Medial approaches preserving quadriceps have not led to an obvious improvement in functional recovery in the short or medium term, however, compared with the progress of patients undergoing surgery via the standard medial parapatellar route. While it may certainly be termed minimally invasive, the medial subvastus approach reduces knee exposure without providing any significant benefits for the patient.

Preserving quadriceps, then, is not enough on its own to improve rehabilitation after total knee replacement. Careful consideration has been given to adapting the approach route to achieve more functional aims, while continuing to observe the basic principles of total knee arthroplasty. To simplify, these functional goals are obtaining extension that allows efficient locking in particular, together with adequate active flexion, which is the hallmark of rapid and easy rehabilitation. In addition, the prosthesis should be placed so that the knee is both mobile and stable, and the position of the implants is compatible with the tribological...

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