JOA - 2026-08-01 - Journal Article; Systematic Review
The Influence of Total Knee Arthroplasty Surgical Approach on Range of Motion, Patient-Reported Outcome Measures, and Reoperation Rates: A Systematic Review of Randomized Controlled Trials.
Rainey JP, Radtke LE, Gililland JM, Mont MA
Topics
Key Takeaway
Across 27 RCTs, no single TKA surgical approach consistently outperforms standard medial parapatellar in ROM, PROMs, or reoperation rates, though subvastus was favored in 3 ROM studies and 3 PROM studies.
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Summary
This systematic review of 27 RCTs (PubMed/Embase, 2010–2024) compared TKA surgical approaches on ROM, PROMs, and reoperation rates. Of 25 ROM studies, 7 favored a quad-sparing approach (3 subvastus, 2 midvastus, 2 mini-MPP) while 18 found no difference; of 26 PROM studies, 7 favored a non-standard approach while 19 found no difference. No approach demonstrated consistent superiority across all three outcome domains.
Key Limitation
Absence of patient-level meta-analysis prevents determination of whether subgroup populations (e.g., obese patients, stiff knees, revision risk) derive differential benefit from any specific approach.
Original Abstract
BACKGROUND
Various surgical approaches may be used to perform total knee arthroplasty (TKA). This systematic review assessed randomized controlled trials (RCTs) evaluating various TKA approaches and their influence on knee range of motion (ROM), patient-reported outcome measures (PROMs), and reoperation rates.
METHODS
A search of PubMed and Embase databases was performed for manuscripts published between January 1, 2010, and December 31, 2024. Inclusion criteria consisted of RCTs evaluating knee ROM, PROMs, and reoperation rates of various TKA surgical approaches. Modified Coleman methodology scoring and level of evidence were assigned to each study. Non-English manuscripts, studies with fewer than 30 patients in each group, or studies with a mean follow-up of less than three months were excluded. A total of 27 manuscripts met final inclusion, and all were level 1 evidence with fair or better modified Coleman scores (mean 74.9, range 64 to 89).
RESULTS
Among the 25 RCTs that evaluated postoperative knee ROM, three studies supported the subvastus approach, two supported the midvastus approach, and two supported the mini medial parapatellar (MPP) approach when compared to a standard MPP. The remaining 18 studies found no difference in ROM between surgical approaches. Various PROMs were evaluated in 26 studies. Of these, three studies favored the subvastus approach, two favored the midvastus approach, one favored the mini MPP approach, and one favored the standard MPP approach. The remaining 19 studies found no difference in PROMs. Of the 21 studies that evaluated reoperation rates, 10 studies had no reoperations in either group, four studies found no difference in reoperation rates, and seven studies reported on reoperations.
CONCLUSIONS
Based on recent, high-quality RCTs, no single surgical approach consistently outperforms others regarding ROM, PROMs, and reoperation rates. However, a small number of studies demonstrated potential benefits with the subvastus, midvastus, and mini MPP approaches.