Comparing the subvastus and medial parapatellar approaches in total knee replacement

Background: This study aimed to compare the outcomes of the subvastus and medial parapatellar approaches in total knee replacement (TKR), focusing on postoperative pain, knee function recovery, quadriceps strength, hospital stay, complications, and patient satisfaction. Methods: This prospective comparative clinical trial was conducted over 18 months at a tertiary care hospital. A total of 120 patients, aged 50-75 years with knee osteoarthritis, were divided into two groups, group A (subvastus approach) and group B (medial parapatellar approach). Pain, range of motion (ROM), quadriceps strength, length of hospital stay, complications, and patient satisfaction were evaluated postoperatively at 1, 3, 6, and 12 months. Data were analyzed using SPSS, with significance set at p<0.05. Results: Group A showed significantly lower pain at 1 and 3 months, with VAS scores of 4.1 and 2.8, respectively (p<0.05). ROM was significantly greater in Group A at 1 and 3 months (105.2° and 120.8°, p<0.05). Quadriceps strength improved faster in group A at 3 months (MMT score: 4.0, p=0.04). Group A also had a shorter hospital stay (4.5 vs 5.8 days, p=0.01). Complications and long-term satisfaction were similar across both groups. Conclusion: The subvastus approach offers advantages in early recovery, including reduced pain, quicker ROM recovery, and shorter hospital stays. However, long-term outcomes are comparable between both approaches.