2025 ISAKOS Biennial Congress Paper
Comparative Outcomes of Subvastus Versus Paratendinous Approach in Total Knee Arthroplasty Without Tourniquet in a Low Income Country
Ahmed Zendeoui, MD, Tunis, Tunis TUNISIA
Mohamed Amine Gharbi , MD, Tunis TUNISIA
Hichem Abid, MD, Tunis TUNISIA
Houssem Eddine Chahed, MD TUNISIA
Anis Tebourbi, MD, Tunis TUNISIA
Mouadh Nefiss, MD, La Marsa,Tunis TUNISIA
Mongi Slim University Hospital, Marsa, Tunis, TUNISIA
FDA Status Not Applicable
Summary
This study compares the subvastus and paratendinous approaches in total knee arthroplasty without tourniquet, showing that the subvastus approach leads to less blood loss, reduced postoperative pain, better preservation of quadriceps function, and superior long-term functional outcomes, making it an advantageous option in low-income settings.
Abstract
Introduction
Total knee arthroplasty (TKA) is crucial for alleviating pain and restoring function in patients with advanced knee osteoarthritis. The choice of surgical approach can significantly influence recovery outcomes, particularly in low-income countries where postoperative rehabilitation adherence may be inconsistent. This study compares the classic paratendinous approach to the subvastus approach in 80 patients undergoing TKA without a tourniquet, focusing on postoperative recovery, quadriceps function, and long-term functional outcomes.
Materials And Methods
Eighty patients were retrospectively divided into two groups of 40, with one group undergoing the classic paratendinous approach and the other the subvastus approach. Evaluated parameters included intraoperative blood loss (measured in mL) and operative time. Postoperative pain was assessed using the Visual Analog Scale (VAS) at three weeks. Quadriceps function was evaluated by measuring the circumference of the quadriceps intraoperatively and at three months postoperatively. Flexion contracture (flessum) was assessed in degrees at the final follow-up, with a minimum duration of 2 years. Finally, functional recovery was measured using the IKDC score at the last follow-up.
Results
Intraoperative blood loss was significantly lower in the subvastus group, averaging 320 mL compared to 450 mL in the paratendinous group. The operative time was slightly longer in the subvastus group, averaging 95 minutes compared to 85 minutes in the paratendinous group. The subvastus group reported lower postoperative pain levels, with a mean VAS score of 2.1 at three weeks compared to 4.3 in the paratendinous group. The paratendinous group showed a greater reduction in quadriceps circumference, indicating more significant hypotrophy, with a mean decrease of 7.8% compared to 3.5% in the subvastus group. The mean degree of flessum at the final follow-up was 5.6° in the paratendinous group versus 2.5° in the subvastus group. The mean IKDC score at the final follow-up was 85.4 in the subvastus group versus 74.2 in the paratendinous group.
Conclusion
The subvastus approach for TKA offers significant benefits in terms of reduced intraoperative blood loss, lower postoperative pain, and preservation of quadriceps function. These advantages contribute to better long-term functional outcomes, particularly in low-income settings where access to consistent postoperative rehabilitation may be limited. Despite a slightly longer operative time, the subvastus approach presents a compelling option for improving patient recovery and overall outcomes in these populations.