lateral subvastus approach for Total Knee Arthroplasty: shorter recovery time

Background: Traditional minimally invasive total knee arthroplasty (TKA) focuses on reducing incision length and quadriceps trauma via medial midvastus or subvastus approaches. However, these techniques often fail to demonstrate superior functional recovery compared to the standard medial parapatellar route, as preserving the quadriceps alone may be insufficient for optimizing postoperative rehabilitation.

Objective: This article evaluates the lateral subvastus approach as a functional alternative for TKA, aiming to improve extensor apparatus mechanics, patellar stability, and rapid mobilization regardless of preoperative limb deformity.

Key Points: The lateral subvastus route preserves the medial retinaculum and the medial capsuloligamentous complex, which are critical for maintaining patellar alignment and quadriceps efficiency. The technique involves a lateral parapatellar incision, dissection of the vastus lateralis, and medial patellar luxation. In a series of 263 procedures, the approach was compatible with both cruciate-retaining and posterior-stabilized implants, often utilizing computer navigation. Clinical data from 191 patients showed an average surgical time of 97 minutes and a mean hospital stay of 2.9 days. At one-month follow-up, 72% of patients ambulated without assistive devices, and mean flexion reached 105°. The preservation of anterior knee sensitivity allowed early kneeling, while intact medial structures provided superior joint stability.

Conclusion: The lateral subvastus approach is a viable minimally invasive technique that enhances early functional recovery and reduces postoperative pain. By maintaining the integrity of the medial stabilizers and the extensor mechanism, it facilitates rapid rehabilitation and ensures anatomical patellar tracking.