title: Total knee arthroplasty using subvastus approach in stiff knee: A retrospective analysis of 110 cases.
abstract: BACKGROUND
  Subvastus approach used in total knee arthroplasty (TKA) is known to produce an earlier recovery but is not commonly utilized for TKA when the preoperative range of motion (ROM) of the knee is limited. Subvastus approach is known for its ability to give earlier recovery due to less postoperative pain and early mobilization (due to rapid quadriceps recovery). Subvastus approach is considered as a relative contraindication for TKA in knees with limited ROM due to difficulty in exposure which can increase risk of complications such as patellar tendon avulsion or medial collateral injury. Short stature and obesity are also relative contraindications. Tarabichi successfully used subvastus approach in knees with limited preoperative ROM. However, there are no large series in literature with the experience of the subvatus approach in knees with limited preoperative ROM. We are presenting our experience of the subvastus approach for TKA in knees with limited ROM.
  
  
  METHODS
  We conducted retrospective analysis of patients with limited preoperative ROM (flexion ≤90°) of the knee who underwent TKA using subvastus approach and presenting the 2 years results. There were a total 84 patients (110 knees) with mean age 64 (range 49-79 years) years. The mean preoperative flexion was 72° (range 40°-90°) with a total ROM of 64° (range 36°-90°).
  
  
  RESULTS
  Postoperatively knee flexion improved by mean 38° (P < 0.05) which was significant as assed by Student's t- test. The mean knee society score improved from 36 (range 20-60) to 80 (range 70-90) postoperatively (P < 0.05). There was one case of partial avulsion of patellar tendon from the tibial tubercle.
  
  
  CONCLUSIONS
  We concluded that satisfactory results of TKA can be obtained in knees with limited preoperative ROM using subvastus approach maintaining the advantages of early mobilization.
authors.affiliation: Department of Orthopaedics, Bombay Hospital, Mumbai, Maharashtra, India.
authors.forename: Nilen A
authors.initials: NA
authors.lastname: Shah
authors.affiliation: Department of Orthopaedics, Bombay Hospital, Mumbai, Maharashtra, India.
authors.forename: Hitendra Gulabrao
authors.initials: HG
authors.lastname: Patil
authors.affiliation: Department of Orthopaedics, Bombay Hospital, Mumbai, Maharashtra, India.
authors.forename: Vinod O
authors.initials: VO
authors.lastname: Vaishnav
authors.affiliation: Department of Orthopaedics, Bombay Hospital, Mumbai, Maharashtra, India.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Savale
keywords: Knee replacement; Limited preoperative range of motion; arthroplasty replacement; knee; osteoarthritis; subvastus approach; total knee arthroplasty