Subvastus approach supporting fast-track total knee arthroplasty over the medial parapatellar approach : A systematic review and network meta-analysis

Numerous surgical approaches are being used to perform total knee arthroplasty (TKA). However, there is a lack of knowledge about which approach provides the fastest rehabilitation after surgery. Therefore, this systematic review and network meta-analysis aimed to compare surgical approaches used in TKA regarding postoperative outcomes at different time points.We performed a literature search in three medical databases from inception until October 2, 2021. We searched for randomized controlled trials (RCTs) investigating patients undergoing TKA and comparing at least two surgical approaches regarding early postsurgical clinical outcomes at different time points (range of motion (RoM), pain on a visual analog scale (VAS), and Knee Society Score (KSS). We included 33 RCTs in our networks. Using paired and network meta-analysis, we calculated pooled mean differences (MDs) with 95% confidence intervals (CIs) by comparing surgical approaches to the medial parapatellar method.The subvastus method performed the best on days 1 (MD=6.99;CI:1.08;12.89), 3 (MD=8.00;CI:2.08;13.92), 4 (MD=27.01;CI:18.09;35.92), and 6 (MD=27.22;CI:18.38;36.07) for RoM improvement. Regarding the decrease in pain, the mini subvastus approach offered significantly lower pain values on days 1 (MD=-1.98;CI:-2.93;-1.03), 3 (MD=-0.85;CI:-1.49;-0.22), and 7 (MD=-1.90;CI:-2.23;-1.57). In the later rehabilitation period, the differences decreased as time passed. Furthermore, the subvastus and mini-subvastus methods performed the best regarding total, knee and function KSS.Quadriceps-sparing approaches, but especially the subvastus and mini-subvastus, are superior to the other approaches in the early postsurgical period, the differences decrease as time passes.