Evaluation Of Rapid Recovery After TKA By Transfemoral Medial Muscle Approach And Traditional Parapatellar Medial Approach

Objective To explore the two most commonly used approaches of TKA(total knee arthroplasty),namely total knee arthroplasty by femoral medial muscle approach and total knee arthroplasty by traditional parapatellar medial approach,and to compare the differences in the effect of rapid postoperative recovery between the two approaches.Methods A total of 90 patients with knee osteoarthritis who underwent total knee arthroplasty for the first time between January 2019 and July 2019 were selected as subjects.The patients were randomly divided into two groups: 45 patients in the observation group received vastus medialis approach for total knee replacement,and 45 patients in the control group received parapatellar medial approach for total knee replacement.Of 90 patients with postoperative follow-up of 6 months and record,treatment and rehabilitation in patients with two groups of data are compared,including the length of the incision,operation time,complications and postoperative venous blood flow and postoperative 1 d hemoglobin content,postoperative strength,VAS pain score,KSS score function,the postoperative knee ROM,inflammation and muscle damage level clinical parameters such as contrast,evaluation of two kinds of surgical approach.Results Preoperative statistics showed that there were no significant differences among the 90 patients in BMI,preoperative VAS score,preoperative activity level,KSS score,inflammation level and muscle injury level.According to the intraoperative statistics,the patients in the vastus medialis approach group,that is,the observation group,had smaller incision,less blood loss and less drainage than the control group,and the difference was statistically significant(P<0.05).There were no statistical differences in operation time,postoperative complications,and lateral supportive band release rate(P>0.05).According to the postoperative statistics,the level of inflammation and degree of muscle injury were lower in the vastus medialis approach group,that is,the observation group,and the difference was significant.In the observation group,the time of postoperative active straight leg elevation and 90 degree flexion was earlier,and the recovery of knee joint ROM was better than that of the control group,which had statistical significance.VAS score of the observation group was slightly lower than that of the control group in the first day after surgery,showing a statistical difference.However,VAS score of the two groups at 6 weeks after surgery showed no statisticaldifference(P=0.55).KSS scores at week 1 and week 6 were compared,and the KSS scores in the observation group were higher than those in the control group,with statistical significance(P<0.05).Conclusion Both the medial femoral approach and the traditional medial parapatellar approach are effective approaches for total knee arthroplasty,which can relieve patients' pain and promote their recovery.Compared with the traditional parapatellar medial approach,the femoral medial approach has less intraoperative blood loss and drainage,less postoperative pain in the early stage,better leg lifting,flexion and other activities,lower inflammation level and degree of muscle injury,earlier activity time and faster functional recovery.Therefore,the vastus medialis approach has a better effect on the rapid postoperative recovery of patients.Compared with the parapatellar medial approach in clinical treatment,it can preserve the quadriceps tendon and muscle integrity,reduce the surgical trauma and have a higher early efficacy.It should be noted that TKA through the medial femoral approach is difficult and has high technical requirements,and the patient is required to have no serious knee deformity,obesity,strong quadriceps muscles,lower patella and hyperosteoplasia,and other contrains.In the actual treatment,the choice should be made according to the actual conditions of the surgeon and the patient.