J Knee Surg
DOI: 10.1055/s-0043-1777077
Original Article

Lateral Subvastus Lateralis versus Medial Parapatellar Approach for Total Knee Arthroplasty: Patient Outcomes and Kinematics Analysis

1   Department of Orthopaedic Surgery, Western University, London, Ontario, Canada
Jordan S. Broberg
1   Department of Orthopaedic Surgery, Western University, London, Ontario, Canada
Ryan Willing
1   Department of Orthopaedic Surgery, Western University, London, Ontario, Canada
Matthew G. Teeter
1   Department of Orthopaedic Surgery, Western University, London, Ontario, Canada
Brent A. Lanting
1   Department of Orthopaedic Surgery, Western University, London, Ontario, Canada
› Author Affiliations
Funding None.


The conventional approach for total knee arthroplasty (TKA) is a medial parapatellar approach (MPA). We aimed to study patient outcomes and kinematics with a quadriceps sparing lateral subvastus lateralis approach (SLA). Patients with neutral/varus alignment undergoing primary TKA were consented to undergo the SLA. At 1-year postoperative, patients underwent radiostereometric analysis. Patients were administered the Short Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Society Score (KSS). Kinematics and outcome data were compared to a group undergoing TKA via conventional MPA. Fourteen patients underwent TKA via SLA with a mean age 71.5 ± 8.0 and mean body mass index (BMI) 31.0 ± 4.5. The MPA group had 13 patients with mean age 63.4 ± 5.5 (p = 0.006) and mean BMI 31.2 ± 4.6 (p = 0.95). The SLA resulted in a significantly more posterior medial contact point at 0 (p = 0.011), 20 (p = 0.020), and 40 (p = 0.039) degrees of flexion. There was no significant difference in medial contact point from 60 to 120 degrees, lateral contact point at any degree of flexion, or axial rotation. There was no difference in improvement in postoperative WOMAC, SF-12, KSS function, and total KSS knee scores between groups. The MPA group had a significantly greater improvement in KSS knee scores at 3 months (p < 0.001), 1 year (p = 0.003), and 2 years (p = 0.017). The SLA resulted in increased medial femoral rollback early in flexion. Although both approaches resulted in improved postoperative outcomes, the MPA group showed significantly greater improvements in KSS knee scores at 3 months, 1 year, and 2 years. Further studies are required to identify any benefits that the SLA may offer.

Level of Evidence Therapeutic Level II

Publication History

Received: 05 February 2023

Accepted: 23 October 2023

Article published online:
22 November 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
  • 2 Van Onsem S, Verstraete M, Van Eenoo W, Van Der Straeten C, Victor J. Are TKA kinematics during closed kinetic chain exercises associated with patient-reported outcomes? A preliminary analysis. Clin Orthop Relat Res 2019
  • 3 Vaishya R, Vijay V, Demesugh DM, Agarwal AK. Surgical approaches for total knee arthroplasty. J Clin Orthop Trauma 2016; 7 (02) 71-79
  • 4 Stern SH, Moeckel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop Relat Res 1991; (273) 5-8
  • 5 Von Langenbeck B. Zur resection des kniegellenks. Verhandlungen der Deutschen Gesellschaft fur Churg. 1878; 7: 23-30
  • 6 Legault JA, Beveridge TS, Johnson MI, Lanting BA. Subvastus lateralis approach to total knee arthroplasty – a cadaveric evaluation. 2018; 32 (1_supplement): 644.7-644.7
  • 7 Sidhu SP, Moslemian A, Yamomo G. et al. Lateral subvastus lateralis versus medial parapatellar approach for total knee arthroplasty: a cadaveric biomechanical study. Knee 2020; 27 (06) 1735-1745
  • 8 Teeter MG, Perry KI, Yuan X, Howard JL, Lanting BA. Contact kinematic differences between gap balanced vs measured resection techniques for single radius posterior-stabilized total knee arthroplasty. J Arthroplasty 2017; 32 (06) 1834-1838
  • 9 Williams HA, Broberg JS, Howard JL, Lanting BA, Teeter MG. Effect of gap balancing and measured resection techniques on implant migration and contact kinematics of a cementless total knee arthroplasty. Knee 2021; 31: 86-96
  • 10 Broberg JS, Ndoja S, MacDonald SJ, Lanting BA, Teeter MG. Comparison of contact kinematics in posterior-stabilized and cruciate-retaining total knee arthroplasty at long-term follow-up. J Arthroplasty 2020; 35 (01) 272-277
  • 11 Morcos MW, Lanting BA, Webster J, Howard JL, Bryant D, Teeter MG. Effect of medial soft tissue releases during posterior-stabilized total knee arthroplasty on contact kinematics and patient-reported outcomes. J Arthroplasty 2019; 34 (06) 1110-1115
  • 12 Angerame MR, Holst DC, Jennings JM, Komistek RD, Dennis DA. Total knee arthroplasty kinematics. J Arthroplasty 2019; 34 (10) 2502-2510
  • 13 Broberg JS, Naudie DDR, Howard JL, Vasarhelyi EM, McCalden RW, Teeter MG. Contact kinematics of patient-specific instrumentation versus conventional instrumentation for total knee arthroplasty. Knee 2020; 27 (05) 1501-1509
  • 14 Gandek B, Ware JE, Aaronson NK. et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51 (11) 1171-1178
  • 15 Bellamy N. The WOMAC Knee and Hip Osteoarthritis Indices: development, validation, globalization and influence on the development of the AUSCAN Hand Osteoarthritis Indices. Clin Exp Rheumatol 2005; 23 (5, Suppl 39): S148-S153
  • 16 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
  • 17 Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y. Clinical and radiographic outcomes of minimally invasive total knee arthroplasty through a lateral approach. Knee Surg Sports Traumatol Arthrosc 2011; 19 (06) 973-979
  • 18 Flandry F, Hommel G. Normal anatomy and biomechanics of the knee. Sports Med Arthrosc Rev 2011; 19 (02) 82-92
  • 19 Freeman MA, Pinskerova V. The movement of the normal tibio-femoral joint. J Biomech 2005; 38 (02) 197-208
  • 20 Most E, Zayontz S, Li G, Otterberg E, Sabbag K, Rubash HE. Femoral rollback after cruciate-retaining and stabilizing total knee arthroplasty. Clin Orthop Relat Res 2003; (410) 101-113
  • 21 Zingde SM, Slamin J. Biomechanics of the knee joint, as they relate to arthroplasty. Orthop Trauma 2017; 31 (01) 1-7
  • 22 Lizaur-Utrilla A, Gonzalez-Parreño S, Martinez-Mendez D, Miralles-Muñoz FA, Lopez-Prats FA. Minimal clinically important differences and substantial clinical benefits for Knee Society Scores. Knee Surg Sports Traumatol Arthrosc 2020; 28 (05) 1473-1478
  • 23 Bin Abd Razak HR, Tan CS, Chen YJD. et al. Age and Preoperative Knee Society Score are significant predictors of outcomes among Asians following total knee arthroplasty. J Bone Joint Surg Am 2016; 98 (09) 735-741
  • 24 Batailler C, Lording T, De Massari D, Witvoet-Braam S, Bini S, Lustig S. Predictive models for clinical outcomes in total knee arthroplasty: a systematic analysis. Arthroplast Today 2021; 9: 1-15
  • 25 Maldonado DR, Laseter JR, Kyin C, Lall AC, Domb BG. Direct anterior approach in total hip arthroplasty leads to superior outcomes at 3-month follow-up when compared with the posterior approach: a matched study using propensity score analysis. J Am Acad Orthop Surg Glob Res Rev 2019; 3 (12) e19.00118
  • 26 Torres A, Goldberg T, Bush JW, Mahometa MJ. Learning curve for direct anterior approach for total hip arthroplasty. Orthop Proc 2019; 101-B (SUPP_4): 66-66