Clinical and Radiological Outcomes of Total Knee Arthroplasty Performed with Midvastus and Medial Parapatellar Approaches in Obese Patients

Background. The use of total knee arthroplasty (TKA) for primary osteoarthritis of the knee has remarkably increased recently. We aimed to compare the clinical and radiological outcomes of TKA in obese patients (>30 kg/m2) operated with midvastus (MV) or medial parapatellar (MPP) approaches. Methods. This retrospective study was performed using data derived from 80 patients (70 women; 10 men) with an average age of 66.17 ± 5.42 (range: 54 to 77). Patients were allocated into 2 groups as for the type of approach conducted during TKA: group I (n = 41) underwent TKA by MV approach, while the MMP technique was used in group II (n = 39). Results. Demographic, clinical, and radiological parameters included age, side of involvement, sex, BMI, diameters of thigh and calf, length of incision, duration of operation, amount of bleeding and transfusion, duration of hospitalization and follow-up, complications, and range of motion, as well as Knee Society Score (KSS) and Knee Society Function Score (KSFS). Patients with a higher BMI (≥35 kg/m2) experienced more profound bleeding and needed more transfusion of erythrocyte suspension. The range of motion was more favorable in groups with BMI <35 kg/m2. The functional outcomes as reflected in KSS and KSFS were much better in patients with BMI <35 kg/m2. Conclusions. Our data indicated that obesity can adversely influence the clinical and radiological outcomes after TKA performed by both MV and MPP approaches. A careful analysis of patient characteristics and selection of appropriate operative procedures is critical. Further randomized, controlled trials on larger series must be designed to elucidate the relationship between obesity and therapeutic outcomes after TKA with different approaches.

Evaluation of Clinical and Radiographic Outcomes of Subvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty

Introduction: The aim of this study is to compare clinically and radiologically the subvatus (SV) and medial parapatellar (MPP) approaches performed in patients undergoing total knee arthroplasty (TKA) due to severe gonarthrosis. Materials and methods: Patients who underwent TKA between 2015 and 2019 were divided into two groups, SV and MPP, according to the type of approach performed. Demographic, clinical, and surgical information of the patients were evaluated. Knee Society Clinical Rating System (KSS) and visual analogue scale (VAS) scores were used for functional evaluation. AP and lateral orthoroentgenograms and knee radiographs taken at the last follow-up were used for radiological evaluation. Results: The mean duration of surgery and tourniquet was significantly higher in the SV group. (p <.001 and p <.001, respectively). Mean blood loss and number of blood transfusions were significantly higher in the MPP group. (p <.001 and p <.001, respectively). Opiate analgesic need, straight leg raising time and hospitalization time were also significantly higher in the MPP group. (p <.001, p <.001 and p <.001, respectively). Although the KSS, VAS scores, and the range of motion at the first month were better in the SV group, there was no difference between the two groups at 6 and 12 months. Conclusion: According to this study, with the SV approach used for TKA, postoperative blood loss and the need for transfusion decreased, the duration of hospitalization was shortened, postoperative pain was less, and functional scores were better. The only disadvantage is the prolonged operation time

Systematic Postoperative Assessment of a Minimally-Invasive Sheep Model for the Treatment of Osteochondral Defects

To assess the clinical course of a sheep stifle joint model for osteochondral (OC) defects, medial femoral condyles (MFC) were exposed without patella luxation using medial parapatellar skin (3–4 cm) and deep incisions (2–3 cm). Two defects (7 mm diameter; 10 mm depth; OC punch) were left empty or refilled with osteochondral autologous transplantation cylinders (OATS) and explanted after six weeks. Incision-to-suture time, anesthesia time, and postoperative wound or impairment scores were compared to those in sham-operated animals. Implant performance was assessed by X-ray, micro-computed tomography, histology, and immunohistology (collagens 1, 2; aggrecan). There were no surgery-related infections or patellar luxations. Operation, anesthesia, and time to complete stand were short (0.5, 1.4, and 1.5 h, respectively). The wound trauma score was low (0.4 of maximally 4; day 7). Empty-defect and OATS animals reached an impairment score of 0 significantly later than sham animals (7.4 and 4.0 days, respectively, versus 1.5 days). Empty defects showed incomplete healing and dedifferentiation/heterotopic differentiation; OATS-filled defects displayed advanced bone healing with remaining cartilage gaps and orthotopic expression of bone and cartilage markers. Minimally-invasive, medial parapatellar surgery of OC defects on the sheep MFC allows rapid and low-trauma recovery and appears well-suited for implant testing.