Elsevier

The Journal of Arthroplasty

Volume 27, Issue 6, June 2012, Pages 1123-1127.e1
The Journal of Arthroplasty

A Comparison of Patellar Vascularity Between the Medial Parapatellar and Subvastus Approaches in Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2012.01.013Get rights and content

Abstract

A complication of total knee arthroplasty is patellar avascular necrosis. Surgical approaches for total knee arthroplasty include the medial parapatellar approach (MPa) and, less commonly, the subvastus approach (SVa). The argument that SVa retains better patellar vascularity than the MPa was investigated on 20 participants, (SVa, n = 10; MPa, n = 10) 18 months postoperatively. Outcomes were a radionuclide bone imaging technique, a new bone vascularity scale, and an anterior knee pain numerical assessment scale. Results indicated no significant difference between groups on imaging (P = .935), the components of the bone vascularity scale, or anterior knee pain (P > .999). The SVa appears to offer no benefit over the MPa in terms of patellar vascularity or anterior knee pain.

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Materials and Methods

This study reports the results of a secondary outcome from a larger randomized controlled trial (RCT) investigating the physical and functional outcomes of the MPa and SVa [10] because no previous research has provided empirical data on patellar vascularity from different TKA approaches. The larger RCT was conducted from May 2006 to November 2009, and institutional ethics committee approval was granted for this trial. Written informed consent for all procedures was obtained from each

Results

The 10 participants in the SVa group comprised 3 women and 7 men (mean age, 69.7 years; range, 56-83 years), whereas those in the MPa group included 7 women and 3 men (mean age, 69.8 years; range, 64-86 years). All 20 participants received their allocated surgical approach and participated in the planned postoperative care and rehabilitation. There were no complications, lateral releases, or other contraventions to surgical protocol or follow-up in either group. The raw data for all outcomes is

Discussion

This study found no significant difference between the SVa and MPa for the outcomes of patellar vascularity assessed using radionuclide bone imaging and the clinical BVS. There was also no between-group difference in the mean rating of anterior knee pain at 18 months postoperatively. The hypothesis that the SVa would afford better results for vascularity and anterior knee pain than the MPa because of the extensive dissection of the patellar arterial blood supply in the latter approach was

Acknowledgment

Contributors:

Bone vascularity scale scoring: Dr Peter Jackson, MBBS, FRANZCR.

Data collection: Dr Prudence FitzPatrick, MBBS, FRACS. Tuesday Cole, BNucMed (Hons), GDip (Med Ultrasound). Daniel Kim, MPhty student, University of Queensland. Jade Mitchell, MPhty student, University of Queensland. Peter Rego, MPhty student, University of Queensland. Katherine Schindler, MPhty student, University of Queensland. Lisa Tennant, MPhty student, University of Queensland.

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Supplementary material available at www.arthroplastyjournal.org.

The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2012.01.013.

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