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Published in: Trials 1/2006

Open Access 01-12-2006 | Study protocol

Sub-vastus approach versus the medial parapatellar approach in primary total knee: a randomised controlled trial [ISRCTN44544446]

Authors: Stephen Bridgman, Gayle Walley, Gilbert MacKenzie, Darren Clement, David Griffiths, Nicola Maffulli

Published in: Trials | Issue 1/2006

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Abstract

Background

Thirty thousand knee replacements are performed annually in the UK. There is uncertainty as to the best surgical approach to the knee joint for knee arthroplasty. We planned a randomised controlled trial to compare a standard medial parapatellar arthrotomy with sub-vastus arthrotomy for patients undergoing primary total knee arthroplasty in terms of short and long term knee function.

Methods

Patients undergoing primary total knee arthroplasty at the local NHS Trust are to be recruited into the study. Patients are to be randomised into either the subvastus or medial parapatellar approache to knee arthroplasty. The primary outcome measures will be the American Knee Society and WOMAC Scores. The secondary outcome measures will be patient based measures of EuroQol and SF-36. All outcomes will be measured pre-operatively, 1, 6, 12 and 52 weeks post-operatively. We will also review pain intensity using a pain and analgesia diary. Ease of surgical exposure and complications will also be analysed.

Discussion

Evidence is lacking concerning the best surgical approach to the knee joint for patients undergoing primary total knee replacement. This pragmatic randomised trial tests the hypothesis that the sub-vastus approach is significantly superior to the standard medial parapatellar approach in terms of short and long term knee function.
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Literature
1.
go back to reference Abbot LC, Walter F, Carpenter WF: Surgical approaches to the knee joint. The Journal of Bone and Joint Surgery. 1945, 27 (2): 277-310. Abbot LC, Walter F, Carpenter WF: Surgical approaches to the knee joint. The Journal of Bone and Joint Surgery. 1945, 27 (2): 277-310.
2.
go back to reference Hofmann AA, Plaster RL, Murdock LE: Subvastus (southern) approach for primary total knee arthroplasty. Clinical Orthopaedics. 1991, 269: 70-77. Hofmann AA, Plaster RL, Murdock LE: Subvastus (southern) approach for primary total knee arthroplasty. Clinical Orthopaedics. 1991, 269: 70-77.
3.
go back to reference Fauré BT, Benjamin JB, Lindsey B, Volz RG, Schutte D: Comparison of the subvastus and paramedian surgical approaches in bilateral knee arthroplasty. Journal of Arthroplasty. 1993, 8 (5): 511-516.CrossRefPubMed Fauré BT, Benjamin JB, Lindsey B, Volz RG, Schutte D: Comparison of the subvastus and paramedian surgical approaches in bilateral knee arthroplasty. Journal of Arthroplasty. 1993, 8 (5): 511-516.CrossRefPubMed
4.
go back to reference Maric Z, Ott DM, Karpman RR: The standard versus the sub-vastus (southern) approach for total knee arthroplasty: a randomised prospective study. Orthop Trans. 1991, 15: 43- Maric Z, Ott DM, Karpman RR: The standard versus the sub-vastus (southern) approach for total knee arthroplasty: a randomised prospective study. Orthop Trans. 1991, 15: 43-
5.
go back to reference Bindelglass DF, Vince KG: Patellar tilt and subluxation following subvastus and parapatellar approach in total knee replacement. J Arthropasty. 1996, 11: 507-511.CrossRef Bindelglass DF, Vince KG: Patellar tilt and subluxation following subvastus and parapatellar approach in total knee replacement. J Arthropasty. 1996, 11: 507-511.CrossRef
6.
go back to reference Ogata K, Ishinishi T, Hara M: Evaluation of patellar retinacular tension during total knee arthroplasty. Special emphasis on lateral retinacular release. J Arthroplasty. 1997, 12: 651-656.CrossRefPubMed Ogata K, Ishinishi T, Hara M: Evaluation of patellar retinacular tension during total knee arthroplasty. Special emphasis on lateral retinacular release. J Arthroplasty. 1997, 12: 651-656.CrossRefPubMed
7.
go back to reference Cameron HU, Fedorkow DM: The patella in total knee arthroplasty. Clinical Orthopaedics. 1982, 165: 197- Cameron HU, Fedorkow DM: The patella in total knee arthroplasty. Clinical Orthopaedics. 1982, 165: 197-
8.
go back to reference Wetzner SM: Bone scanning in the assessment of patellar viability following total knee replacement. Clinical Orthopaedics. 1985, 199: 215- Wetzner SM: Bone scanning in the assessment of patellar viability following total knee replacement. Clinical Orthopaedics. 1985, 199: 215-
9.
go back to reference Smigielski M, Gustke K: Southern approach for total knee replacement. Florida Orthopaedic Society, Tampa. 1989 Smigielski M, Gustke K: Southern approach for total knee replacement. Florida Orthopaedic Society, Tampa. 1989
10.
go back to reference EuroQol Group: EuroQol EQ-5D. user guide. 1996 EuroQol Group: EuroQol EQ-5D. user guide. 1996
11.
go back to reference Bellamy N: WOMAC Osteoarthritis Index. A users Guide. 1996, London, Ontario Bellamy N: WOMAC Osteoarthritis Index. A users Guide. 1996, London, Ontario
12.
go back to reference Insall JN, Dorr LD, Scott RD, Scott NW: Rationale for the Knee Society Clinical Rating System. Clinical Orthopaedics and Related Research. 1989, 248: 13-14.PubMed Insall JN, Dorr LD, Scott RD, Scott NW: Rationale for the Knee Society Clinical Rating System. Clinical Orthopaedics and Related Research. 1989, 248: 13-14.PubMed
13.
go back to reference Ware JE, Sherbourne CD: The MOS 36-item short form health survey (SF-36): conceptual framework and item selection. Medical Care. 1992, 30: 473-481.CrossRefPubMed Ware JE, Sherbourne CD: The MOS 36-item short form health survey (SF-36): conceptual framework and item selection. Medical Care. 1992, 30: 473-481.CrossRefPubMed
14.
go back to reference Barrack RL: Resurfacing of the patellar in total knee arthroplasty. Journal of Bone and Joint Surgery. 1997, 79-A (8): 1121-1120. Barrack RL: Resurfacing of the patellar in total knee arthroplasty. Journal of Bone and Joint Surgery. 1997, 79-A (8): 1121-1120.
15.
go back to reference Pocock SJ: Clinical Trials a Practical Approach. Ed John Wiley and Sons. 1996 Pocock SJ: Clinical Trials a Practical Approach. Ed John Wiley and Sons. 1996
16.
go back to reference Engh GA, Parks NL: Surgical technique of the midvastus arthrotomy. Clin Orthop. 1998, 351: 270-274.CrossRefPubMed Engh GA, Parks NL: Surgical technique of the midvastus arthrotomy. Clin Orthop. 1998, 351: 270-274.CrossRefPubMed
17.
go back to reference Engh GA: Midvastus Approach. Surgical Techniques in Total Knee Arthroplasty. Edited by: Scuderi GR, Tria AJ Jr. 2002, New York, Springer-Verlag, 127-130.CrossRef Engh GA: Midvastus Approach. Surgical Techniques in Total Knee Arthroplasty. Edited by: Scuderi GR, Tria AJ Jr. 2002, New York, Springer-Verlag, 127-130.CrossRef
18.
go back to reference Faure BT, Benjamin JB, Lindsey B, Volz RG, Schutte D: Comparison of subvastus and paramedian surgical approaches in bilateral knee arthroplasty. J Arthroplasty. 1993, 8: 511-516.CrossRefPubMed Faure BT, Benjamin JB, Lindsey B, Volz RG, Schutte D: Comparison of subvastus and paramedian surgical approaches in bilateral knee arthroplasty. J Arthroplasty. 1993, 8: 511-516.CrossRefPubMed
19.
go back to reference Roysam GS, Oakley MJ: Subvastus approach for total knee artroplasty. A prosective, randomised and observer-blinded trial. J Arthroplasty. 2001, 16: 454-457.CrossRefPubMed Roysam GS, Oakley MJ: Subvastus approach for total knee artroplasty. A prosective, randomised and observer-blinded trial. J Arthroplasty. 2001, 16: 454-457.CrossRefPubMed
20.
go back to reference Maric Z, Ott DM, Karpman RR: The standard versus the subvastus (southern) approach for total knee arthroplasty: a randomised prospective study. Orthop Trans. 1991, 15: 43- Maric Z, Ott DM, Karpman RR: The standard versus the subvastus (southern) approach for total knee arthroplasty: a randomised prospective study. Orthop Trans. 1991, 15: 43-
Metadata
Title
Sub-vastus approach versus the medial parapatellar approach in primary total knee: a randomised controlled trial [ISRCTN44544446]
Authors
Stephen Bridgman
Gayle Walley
Gilbert MacKenzie
Darren Clement
David Griffiths
Nicola Maffulli
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Trials / Issue 1/2006
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-7-23

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