COMPARISON OF FUNCTIONAL OUTCOME IN MEDIAL PARAPATELLAR VERSUS MIDVASTUS APPROACH AFTER TOTAL KNEE ARTHROPLASTY

Abstract

Objective: To compare early postoperative recovery, functional outcomes, and complication rates between the medial parapatellar and midvastus approaches in primary total knee arthroplasty.

Study Design: Randomized clinical trial.

Place and Duration of Study: Department of Orthopaedic Surgery, Bahawal Victoria Hospital, Bahawalpur, from July 2025 to October 2025.

Methodology: A total of 60 patients with severe knee osteoarthritis undergoing primary total knee arthroplasty were enrolled and randomly allocated into two groups: medial parapatellar approach (n = 30) and midvastus approach (n = 30). Early recovery parameters, postoperative pain scores, length of hospital stay, operative time, and Knee Society Scores at two and twelve weeks were recorded.

Results: Baseline demographic and clinical characteristics were comparable. The midvastus approach demonstrated earlier straight leg raising (2.6 ± 0.7 vs 3.9 ± 0.8 days, p < 0.001), lower postoperative pain scores on day one (4.8 ± 0.8 vs 6.1 ± 0.9, p < 0.001) and day three (3.6 ± 0.6 vs 4.5 ± 0.7, p < 0.001), and shorter hospital stay (4.9 ± 0.9 vs 6.2 ± 1.1 days, p < 0.001). Knee Society Scores were significantly higher in the midvastus group at two weeks (69.8 ± 6.9 vs 62.3 ± 7.4, p < 0.001) and twelve weeks (82.9 ± 6.3 vs 78.6 ± 6.8, p = 0.01). Operative time was slightly longer in the midvastus group (102.6 ± 12.5 vs 96.4 ± 11.2 minutes, p = 0.04).

Conclusion: The midvastus approach in primary total knee arthroplasty offers better early recovery and superior short-term functional outcomes compared to the medial parapatellar approach, without increasing complication rates.