Hakan Zora1, Harun R. Güngör2, Gökhan Bayrak3, Raziye Şavkın3, Nihal Büker3

1Department of Orthopedics and Traumatology, Artvin State Hospital, Artvin, Turkey
2Department of Orthopedics and Traumatology, Pamukkale University Medical Faculty, Denizli, Turkey
3School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey

Keywords: Fast-track protocol, midvastus approach, parapatellar approach, rapid recovery protocol, total knee arthroplasty.


Objectives: This study aims to compare the effects of mini- midvastus (MMV) versus medial parapatellar (MPP) approach on rapid recovery protocols during total knee arthroplasty (TKA).

Patients and methods: This prospective, randomized, single- blinded study was performed in 54 patients (4 males, 50 females; mean age 64.1±6.4 years) diagnosed as primary knee osteoarthritis and planned for unilateral TKA between May 2018 and March 2019. Patients were randomly assigned as MMV (1 male, 26 females; mean age 65±6.4 years) and MPP (3 males, 24 females; mean age 63.2±6.3 years) groups. Rapid recovery TKA protocol and discharge criteria were assembled and all patients were evaluated preoperatively, and at postoperative first and third months. Length of hospital stay (LOS) was recorded for all patients. Hemoglobin and hematocrit values, radiologic assessment of alignment, knee range of motion (ROM), quadriceps muscle strength, Visual Analog Scale (VAS), 30-sec chair-stand test, stair-climb test, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form-36 (SF-36) were used for evaluations by blinded observers.

Results: There was no significant difference in demographic variables between two groups. Operative time in MMV Group (78.1±2.7 min) was significantly longer than the MPP Group (65.9±2.6 min) (p<0.0005). LOSs in the MMV and MPP Groups were 27.6±3.1 hours and 29.1±6.7 hours with no significant difference. There was no statistically significant difference in postoperative measurements between groups in hemoglobin and hematocrit values, radiologic alignment of components, knee ROM, VAS, 30-sec chair-stand test, stair-climb test, WOMAC, KOOS, and SF-36 evaluations (p>0.05). In terms of quadriceps muscle strength gain, we could not find any difference between groups in pre- and postoperative difference of changes (p>0.05).

Conclusion: With the use of contemporary rapid recovery protocols during TKA, MMV approach had no superiority over MPP approach when quadriceps muscle strength, LOS, pain, function, and quality of life were assessed. Longer operative time in the MMV approach compared to MPP approach may be considered as a disadvantage.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

Funding was received from Pamukkale University Scientific Project Department for this study (Project No: 2018TIPF017).


The authors sincerely thank Prof. Dr. Hakan Erbay for his valuable assistance during the preparation of the rapid recovery protocols, and Hande Şenol for data analysis.