Can the Surgical Approach to Total Knee Arthroplasty Influence Early Postoperative Outcomes? - A Comparative Study between Trivector and Medial Parapatellar Approaches.

Background: Trivector approach to total knee arthroplasty (TKA) is a quadriceps tendon sparing approach, whereas the medial parapatellar (MPP) approach involves making a longitudinal incision in quadriceps tendon. We postulated that quadriceps-sparing approach such as trivector should make postoperative rehabilitation easier and ultimately reduce the length of hospital stay.

Objectives: The aim of the study is to compare the early postoperative outcomes of the TKA performed through the trivector and the MPP approaches.

Methodology: We prospectively reviewed the results of 56 consecutive patients operated on by two knee surgeons: one routinely performs trivector and the other an MPP approach. Both the groups consisted of 28 patients each. We looked at operative times, the time taken to perform straight leg raise (SLR), range of movements achieved before discharge, and length of the hospital stay.

Results: The mean time taken for performing the surgery through the MPP approach was 56 min, whereas, for the trivector approach, it was 54 min ( = 0.31). The mean time taken to perform SLR in the MPP approach group was 3.5 days, whereas in the trivector group, the meantime taken for SLR was 2.5 days ( = 0.003). The average extension at the time of discharge in the MPP group was 3.8°, and in the trivector group, it was 0.86° ( = 0.007). The average knee flexion at the time of discharge in the MPP group was 84.2°, whereas in the trivector group, it was 86.5° ( = 0.199). The average hospital stay in the MPP group was 5.96 days, whereas in the trivector group, it was 4.84 days ( = 0.11).

Conclusions: The trivector approach patients took significantly less time to do SLR and achieved a better range of extension before discharge from the hospital. The patients with trivector approach were discharged early by one day, although it is not statistically significant, it is clinically significant.