Subvastus Approach Total Knee Replacement

What is Subvastus Approach Total Knee Replacement?

Total knee replacement or total knee arthroplasty is a surgical procedure in which the worn-out or damaged parts of the knee joint are removed and replaced with artificial knee components called prostheses or implants made of metal, ceramic, or plastic.

The subvastus approach total knee replacement sometimes called “Jiffy” Knee Replacement is a surgical technique used to access the knee joint to perform total knee replacement surgery. This technique aims to minimize trauma to the quadriceps muscle, potentially leading to quicker recovery and improved postoperative outcomes.

The subvastus approach, also known as the "quadriceps-sparing" approach, involves accessing the knee joint by lifting the vastus medialis muscle, one of the quadriceps muscles, without cutting it. By avoiding cutting the quadriceps tendon, the muscle remains intact, which may result in less postoperative pain and faster recovery.

Anatomy of the Knee

The knee is made up of the femur (thighbone), tibia (shinbone), and patella (kneecap). The lower end of the femur meets the upper end of the tibia at the knee joint. A small disc of bone called the patella rests on a groove on the front side of the femoral end. The fibula, another bone of the lower leg, forms a joint with the shinbone. The bones are held together by protective tissues, ligaments, tendons, and muscles. Synovial fluid within the joint aids in the smooth movement of the bones over one another. The meniscus, a soft crescent-shaped area of cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion.

Indications for Subvastus Approach Total Knee Replacement

Subvastus approach total knee replacement is typically recommended for individuals with knee arthritis or damage that has not responded to conservative treatments like medication, physical therapy, or lifestyle changes. The procedure aims at relieving persistent knee pain that significantly impairs daily activities and quality of life caused by conditions such as knee arthritis or knee injury. The suitability of this procedure depends on various factors, including the patient's overall health, age, and specific knee condition.

Preparation for Subvastus Approach Total Knee Replacement

Preparation for subvastus approach total knee replacement surgery may include the following:

• A thorough consultation with your orthopedic surgeon who will evaluate your knee condition, medical history, and overall health to determine if subvastus approach knee replacement is suitable for you.
• Detailed imaging studies, such as CT scans or MRI scans to capture your knee anatomy in three dimensions. These images are used to design a customized surgical plan.
• A review of your medications or supplements you are taking and any allergies you may have.
• Your surgeon may instruct you to avoid certain medications and supplements that can thin the blood and increase the risk of bleeding during surgery.
• You should not consume solids or liquids at least 8 hours prior to surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Subvastus Approach Total Knee Replacement

In general, subvastus approach total knee replacement surgery is performed under general or regional anesthesia and involves the following steps:

• Incision: A skin incision is made over the front of the knee, typically following a medial (inner) alignment to avoid major nerves and blood vessels.
• Muscle Access: The vastus medialis muscle (inner quadriceps muscle) is gently lifted without cutting it. The muscle fibers are separated to access the underlying joint.
• Joint Exposure: The patella (kneecap) is moved aside, and the surgeon gains access to the knee joint. This approach spares the quadriceps tendon and minimizes muscle trauma.
• Bone Preparation: The damaged surfaces of the femur (thigh bone) and tibia (shin bone) are removed and shaped to fit the prosthetic components.
• Implant Placement: The artificial knee components are placed and secured. This includes the femoral, tibial, and often a patellar component.
• Alignment Check: The alignment and movement of the new joint are checked to ensure proper function.
• Closure: The muscle is returned to its normal position, and the incision is closed with sutures or staples.

Postoperative Care

General postoperative care and recovery tips for subvastus approach total knee replacement include:

• Pain Management: Medications and ice packs are recommended to help manage pain and swelling.
• Early Mobilization: Patients are encouraged to start moving and walking soon after surgery to prevent stiffness and promote circulation.
• Physical Therapy: A structured rehabilitation program is designed to help restore knee function and strength.
• Follow-Up Care: Regular check-ups with the surgeon is scheduled to ensure the knee is healing properly and the prosthetic components are functioning well.

Risks and Complications

As with any surgery, some risks and complications may occur with subvastus approach total knee replacement, such as:

• Bleeding
• Infection
• Blood clots or deep vein thrombosis (DVT)
• Persistent pain/stiffness
• Implant wear or failure
• Damage to adjacent soft tissue structures, such as nerve or blood vessels
• General anesthesia risks

Benefits

Benefits associated with subvastus approach total knee replacement include:

• Muscle-sparing approach
• Faster recovery
• Less postoperative pain
• Minimal muscle trauma/scarring
• Early mobility