COMPARISON OF THE SUBVASTUS AND PARAMEDIAN SURGICAL APPROACHES IN BILATERAL KNEE ARTHROPLASTY

A prospective randomized study was performed on 20 patients undergoing one-stage bilateral knee arthroplasty. One knee was exposed using a s tandard median parapatellar arthrotomy and the other knee with a subva stus arthrotomy. All patients underwent quantitative strength testing before surgery and at 1 week, 1 month, and 3 months after surgery. The knees were also evaluated for range of motion, and patients, who were blinded as to the approach used, completed questionnaires at each eva luation period as to their preference, if any, regarding knee pain and level of function. There was no difference in the range of motion bet ween knees exposed with the paramedian or subvastus arthrotomy at any time period. The subvastus knees demonstrated significantly greater st rength at the 1-week and 1-month intervals, but there was no strength difference at the 3-month interval. There were more lateral releases p erformed in the paramedium knees, and three minor complications were r elated to the subvastus approach. Patients who expressed a preference chose the subvastus knee 4:1 over the paramedian knee. The subvastus a pproach offers a reasonable alternative to the paramedian arthrotomy a nd preserves greater quadriceps strength in the early postoperative pe riod.