Medial subvastus versus the medial parapatellar approach for total knee replacement: A systematic review and meta-analysis of randomized controlled trials

•Twenty randomised controlled trials comprising of 1,893 primary total knee replacements were included in this review.
•The subvastus approach conferred superior results for mean difference (MD) in time to regain an active straight leg raise (1.7 days, 95% CI; 1.0, 2.3), visual analogue score for pain on day one (0.8 points on a scale out of 10, 95% CI; 0.2, 1.4), and total range of knee movement at one week (7˚, 95% CI; 3.2, 10.7). The subvastus approach also resulted in fewer lateral releases (odds ratio 0.4, 95% CI; 0.2, 0.7), less perioperative blood loss (MD 57mls, 95% CI; 10.5, 106.4) but prolonged surgical times (MD 9.7 mins, 95% CI; 3.9, 15.6).
•There was no difference in Knee Society Score at 6 weeks or 1 year, or the rate of adverse events including superficial or deep infection, deep vein thrombosis or knee stiffness requiring manipulation under anaesthesia.
•This review demonstrates evidence of early postoperative benefits following the subvastus approach with equivalence between approaches thereafter.