2023 ISAKOS Biennial Congress ePoster
Clinical and Surgical Comparison of the Midvastus versus Transtendon Approach in Total Knee Arthroplasty
Luis Daniel Ramos Montes, MD, Coyoacan, Ciudad de México MEXICO
Emmanuel Aguilar-Salas, MD, PhD, Coyoacan, Ciudad de México MEXICO
Luis Maqueda Quintanilla, MD, Ciudad De México, Ciudad de México MEXICO
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Coyoacan, Ciudad de México, MEXICO
FDA Status Not Applicable
Summary
Comparative analysis of transoperative bleeding, surgical time and postoperative pain, in a patient with grade IV gonarthrosis treated by total knee arthroplasty, comparing the midvastus vs transtendon approach
ePosters will be available shortly before Congress
Abstract
Introduction
Total knee arthroplasty is a procedure commonly performed in orthopedic surgery, whose demand has increased and will increase even more in our country.
In patients with grade IV knee osteoarthritis, in whom conservative treatment has failed, TKA is indicated.
This procedure decreases pain and improves functionality. However, the results according to the approach are different and there is no clarity about which surgical approach is associated with less bleeding, pain and surgical time, midvastus or transtendon.
Objective
to compare bleeding, pain and surgical time according to the type of approach (midvastus and transtendon) in patients undergoing primary total knee arthroplasty due to grade IV osteoarthritis.
Methods
An observational, comparative, retrospective study was carried out based on information from the records of patients who underwent total knee arthroplasty with two approach techniques: midvastus and transtendon in the Joint Surgery Service of the General Hospital ISSSTE South Delegation " Dr. Matilde Petra Montoya Lafragua".
Bleeding was compared between groups by the change in hemoglobin before and after surgery; the intensity of pain with the visual analog scale (VAS) and the surgical time. A value of p<0.05 was considered significant.
Results
99 patients who underwent the midvastus approach (Group M) and 100 patients who underwent the transtendon approach (Group T), with a mean age of 70.1 ± 5.7 years and 70.6 ± 5.8 years, respectively (p= 0.584), were included.
The operated side was the right in 49.5% of the patients in group M and in 45% of the patients in group T; and it was the left side in 50.5% of the patients in group M and in 55% of the patients in group T (p=0.525).
Preoperative hemoglobin was 14.7 ± 2.1 g/L in group M and 15.2 ± 1.3 g/L in group T (p=0.021).
After surgery in both groups a significant decrease in hemoglobin levels (p<0.001); in group M the reduction was 5.0 ± 1.4 g/L and in group T it was 4.6 ± 1.8 g/L (p=0.110).
After the intervention there was a significant reduction in pain in both groups without significant differences between groups; from 6.7 ± 1.8 points before surgery in group M to 3.2 ± 2.1 points after surgery in group M (p<0.001) and from 6.7 ± 1.8 points before surgery in group T to 3.1 ± 1.5 points after surgery in group T (p<0.001).
Surgical time was significantly longer with the transtendon approach. (98.7±18.0 versus 89.2±15.8 minutes, p<0.001).
CONLUSIONS The midvasto approach shows a reduction in postoperative hemoglobin levels and a similar reduction in postoperative pain compared to the transtendon approach.
However, the midvasto approach reduces the transoperative time compared to the transtendon technique.