title: Subvastus versus medial parapatellar approach in total knee arthroplasty: meta-analysis.
abstract: The subvastus and medial parapatellar approaches are 2 commonly performed techniques in total knee arthroplasty, but the optimal approach for total knee arthroplasty remains controversial. The purpose of this study was to compare the effectiveness and safety of the subvastus vs medial parapatellar approach.The PubMed, Embase, Cochrane Library, Inter-Services Intelligence Web of Knowledge, and Chinese Biomedical Literature databases were searched for eligible quasi-randomized, controlled and randomized, controlled trials. Two authors independently extracted data and assessed the methodological quality of the included studies according to the Cochrane handbook version 5.1.0. Statistical analysis was performed using Review Manager version 5.1 software. Eight randomized, controlled trials and 1 quasi-randomized, controlled trial involving 940 primary total knee arthroplasties were included for meta-analysis. Meta-analysis revealed significant differences favoring the subvastus group in Knee Society Score in terms of function at 4 to 6 weeks (weighted mean difference [WMD]=5.09; 95% confidence interval [CI], 3.08 to 7.09; P<.01) and knee score at 12 months (WMD=2.17; 95% CI, 0.01 to 4.34; P=.05) and lateral retinacular release (odds ratio=0.34; 95% CI, 0.14 to 0.79; P=.01) when compared with the medial parapatellar approach. However, both groups showed similar results in range of motion (P>.05), operative time (WMD=2.15; 95% CI, -3.61 to 7.35; P=.42), blood loss (WMD= -31.07; 95% CI, -91.89 to 29.75; P=.32), hospital stay (WMD= -0.18; 95% CI, -0.67 to 0.31; P=.47), and postoperative complications (P>.05).
authors.affiliation: Orthopedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou City, Gansu Province, China.
authors.forename: Yuanjun
authors.initials: Y
authors.lastname: Teng
authors.forename: Wenjia
authors.initials: W
authors.lastname: Du
authors.forename: Jin
authors.initials: J
authors.lastname: Jiang
authors.forename: Xuren
authors.initials: X
authors.lastname: Gao
authors.forename: Shumei
authors.initials: S
authors.lastname: Pan
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Liping
authors.initials: L
authors.lastname: An
authors.forename: Jinglin
authors.initials: J
authors.lastname: Ma
authors.forename: Yayi
authors.initials: Y
authors.lastname: Xia
mesh_terms: D001172:Arthritis, Rheumatoid / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D007902:Length of Stay; D020370:Osteoarthritis, Knee / Q000601:surgery; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome