International Journal of Physiotherapy and Research

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Type of Article : Original Research

Year: 2015 | Volume 3 | Issue 1 | Page No. 885-888

Date of Publication: 11-02-2015

DOI: 10.16965/ijpr.2015.103


Gokarakonda Sree Vamsi *1, Antony Leo Aseer.P 2.  

*1 Assistant professor, SRET College of Physiotherapy, MIMS Campus, Nellimarla, Vizianagaram, Andhra Pradesh, India.
2 Reader, Dept. of Physiotherapy, Sri Ramachandra University, Chennai, Tamilnadu, India.

Corresponding author: Mr. G. Sree Vamsi, Door No.: 1-1-96, Vivekananda Colony, Akkireddipalem, Visakhapatnam-530012, Andhra Pradesh, India. Phone No.: +917702020686 E-Mail:


Background: The most common approaches used in Total Knee Replacement surgery are Midvastus, subvastus, median parapetellar, lateral patellar and trivector approach. There is uncertainty as to the best surgical approach to the knee joint for knee replacement. Median parapetellar approach is the standard of practice, but off late quadriceps sparing approaches as like subvastus and midvastus are performed. Subvastus approach has its own limitation of less joint exposure. In our clinical setup, orthopaedic surgeons perform median parapetellar and midvastus approach. The present study has compared outcome of knee function between a standard median parapetellar arthrotomy and mid vastus arthrotomy for patients undergone primary total knee arthroplasty. The post op quadriceps function depend on the type of surgical approach
Materials and methods: 30 subjects were recruited who had undergone Total knee arthroplasty with Median parapetellar and Midvastus approach at Sri Ramachandra medical hospital; received standard physiotherapy care. The pre-op and post quadriceps angle were measured and the quadriceps, hamstrings isometric muscle strength and 6 minute walk test  of the patients were recorded at the time of discharge and after one month of follow-up, and the data were statistically analyzed.
Results: Median parapetellar and Midvastus approach were significant within the groups; with respect to quadriceps angle (QA) (p<0.05), isometric strength of quadriceps (QS) (p<0.05) and 6 minute walk test (WT) (p<0.05). On comparing between the groups at one month follow-up isometric strength of hamstrings (HS) (p<0.01) and 6 minute walk test (p<0.01) were found to be significant.
Discussion: Findings show that Mid-vastus approach provides better results in terms of quadriceps angle, isometric strength of quadriceps and 6 minute walk test compared to median parapetellar approach.
Conclusion: Study concludes that, the isometric strength of quadriceps and hamstrings has improved at the time of discharge and after one month of follow up (within the group). However no much significant changes seen between the groups.
KEYWORDS: Midvastus, Median parapetellar Approach, Total knee replacement, Isometric strength of quadriceps, isometric strength of hamstrings six minute walk test.


  1. Hofmann AA, Plaster RL, Murdock LE. Subvastus (southern) approach for primary total knee arthroplasty. Clin.orthop Relat Res. 1991;269:70–77.
  2. Yuanjun Teng, MM; Wenjia Du, MM; Jin Jiang, MM; Xuren Gao, MD; Shumei Pan, MM; Jing Wang, MD; Liping An, PhD; Jinglin Ma, MS; Yayi Xia, MD, PhD. Subvastus Versus Medial Parapatellar Approach in Total Knee Arthroplasty:Meta-analysis, Orthopedics 2012;35(12): e1722-e1731.
  3. Stephen Bridgman, Gayle Walley, Gilbert MacKenzie, Darren Clement, David Griffiths and Nicola Maffulli. Mid-vastus approach versus the medial parapetellar approach in primary total knee: a randomised controlled trial. Trials. 2006; 7: 23.  Published: 31 July 2006.
  4. Young Bok Jung, Yong Seuk Lee, Eun Yong Lee, Ho Joong Jung,and Chang Hyun Nam. Comparison of the modified subvastus and medial parapetellar approaches in total knee arthroplasty, Int Orthop. Apr 2009; 33(2): 419–423.
  5. Roberta E.Rikli and C.Jessie jones. The reliability and validity of six minute walk test as a measure of physical endurance in older adults,journal of aging and physical activity,1988;6:363-375.
  6. Won Kuel Kim, MD, Don-Kyu Kim, MD, Kyung Mook Seo, MD, and Si Hyun Kang. Reliability and Validity of Isometric Knee Extensor Strength Test With Hand-Held Dynamometer Depending on Its Fixation: A Pilot Study, Ann Rehabil Med. Feb 2014; 38(1): 84–93.


Gokarakonda Sree Vamsi, Antony Leo Aseer.P. MEDIAN PARAPETELLAR VERSUS MIDVASTUS APPROACH ON THE OUTCOMES IN TOTAL KNEE REPLACEMENT. Int J Physiother Res 2015;3(1):885-888. DOI: 10.16965/ijpr.2015.103




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