Subvastus approach in robotic total knee arthroplasty
https://doi.org/10/17238/issn2226-2016.2026.1.30-38
Abstract
Background: the high rate of unsatisfactory outcomes following total knee arthroplasty (TKA) necessitates continuous refinement of surgical techniques, including the implementation of minimally invasive approaches and robotic-assisted systems.
Objective: To evaluate the efficacy of robotic-assisted TKA utilizing the subvastus approach compared with conventional manual TKA.
Materials and Methods: This prospective randomized controlled trial enrolled 60 patients with stage III knee osteoarthritis (Kellgren-Lawrence grade). The study group (n=31) underwent robotic-assisted TKA via subvastus approach; the control group (n=29) received manual TKA through medial parapatellar approach. Primary outcomes included pain intensity (VAS), functional recovery (KOOS), and knee range of motion assessed up to 12 months postoperatively.
Results: In the early postoperative period (postoperative days 1, 3, 5, and month 1), the robotic subvastus group demonstrated statistically significant reductions in pain scores (p < 0.05), greater knee range of motion, and superior KOOS functional scores. Analgesic requirements during hospitalization were 32.5 % lower in the study group. By 6 and 12 months, intergroup differences were no longer statistically significant.
Conclusion: The subvastus approach in robotic-assisted TKA significantly reduces early postoperative pain and accelerates functional rehabilitation compared to conventional manual TKA performed through medial parapatellar approach.
Keywords
arthroplasty,
replacement, knee,
osteoarthritis, knee,
robotic surgical procedures,
rehabilitation,
pain,
postoperative
Supporting agencies: The study had no sponsorship
About the Authors
O. V. Pimanchev
Federal State Budgetary Institution “National Medical and Surgical Center named after N.I. Pirogov” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Oleg V. Pimanchev, MD, PhD, Head of the Center, Head of the Department
Center of Traumatology and Orthopedics; Department of Traumatology and Orthopedics
105203; Nizhnyaya Pervomayskaya Street, house 70; Moscow
R. P. Nebelas
Federal State Budgetary Institution “National Medical and Surgical Center named after N.I. Pirogov” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Roman P. Nebelas, MD, Orthopedic Trauma Surgeon
Center of Traumatology and Orthopedics
105203; Nizhnyaya Pervomayskaya Street, house 70; Moscow
Yu. V. Ryapolov
Federal State Budgetary Institution “National Medical and Surgical Center named after N.I. Pirogov” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Yury V. Ryapolov, MD, Assistant Professor
Department of Traumatology and Orthopedics; Center for Traumatology and Orthopedics
105203; Nizhnyaya Pervomayskaya Street, house 70; Moscow
V. V. Gavriliuk
Federal State Budgetary Institution “National Medical and Surgical Center named after N.I. Pirogov” of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Vladislav V. Gavriliuk, Clinical Resident
Postgraduate Medical Education Institute; Department of Traumatology and Orthopedics
105203; Nizhnyaya Pervomayskaya Street, house 70; Moscow
D. A. Romanov
Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation
Russian Federation
Dmitry A. Romanov, MD, PhD, Assistant Professor
Department of Traumatology, Orthopedics and Disaster Surgery
119991; Trubetskaya St., house 8, building 2; Moscow
References
1. Lychagin A.V., Gritsyuk A.A., Rukin Ya.A., Elizarov M.P., Gritsyuk A.A., Gavlovsky M.Ya., Bogatov T.V. Clinical evaluation and accuracy of mechanical axis alignment in robotic total knee arthroplasty. Genij Ortopedii. 2023;29(5):487-494. (in Russian). doi: 10.18019/1028-4427-2023-29-5-487-494.
2. Kuzin V.V., Kuzin A.V., Germanov A.V., Shpak M.A. Impact of personalized alignment technique on implant components position in total knee arthroplasty. Genij Ortopedii. 2025;31(1):12-18. (in Russian). doi: 10.18019/1028-4427-2025-31-1-12-18.
3. Gerasenkova A.D., Orletsky A.K., Shumsky A.A., Krylov S.V., Dgebuadze G. Early results of primary robot-assisted knee endoprosthetics using the STRYKER MAKO system. Sovremennye problemy nauki i obrazovaniya. 2024;112(2): Art 13. (in Russian). doi: 10.17513/spno.33312.
4. Tsed A.N., Kozhevin A.A., Mushtin N.E. Current trends in early rehabilitation of patients after total hip and knee replacement. Grekov's Bulletin of Surgery. 2024;183(1):60-65. (in Russian). doi: 10.24884/0042-4625-2024-183-1-60-65.
5. Вadawi I., Ismail A., Waly A., Khalkaf M. Prospective comparative study of medial parapatellar and medial subvastus approaches in total knee arthroplasty. Genij Ortopedii. 2024;30(4):511-521. doi: 10.18019/1028-4427-2024-30-4-511-521.
6. Sokolovskii SE, Zykin AA, Rukina NN, Malyshev EE. Minimally Invasive (Epivastus) Approach for Total Knee Arthroplasty. Sovrem Tekhnologii Med. 2023;15(4):23-28. doi: 10.17691/stm2023.15.4.02.
7. Tria AJ Jr, Coon TM. Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res. 2003 Nov;(416):185-90. doi: 10.1097/01.blo.0000093030.56370.d9.
8. Tria AJ, Scuderi GR. Minimally invasive knee arthroplasty : An overview. World J Orthop. 2015 Nov 18;6(10):804-11. doi: 10.5312/wjo.v6.i10.804.
9. Li C, Zeng Y, Shen B, Kang P, Yang J, Zhou Z, Pei F. A meta-analysis of minimally invasive and conventional medial parapatella approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015 Jul;23(7):1971-85. doi: 10.1007/s00167-014-2837-4.
10. Başarir K, Erdemli B, Tuccar E, Esmer AF. Safe zone for the descending genicular artery in the midvastus approach to the knee. Clin Orthop Relat Res. 2006 Oct;451:96-100. doi: 10.1097/01.blo.0000223995.79894.5e.
11. Pagnano MW, Meneghini RM. Minimally invasive total knee arthroplasty with an optimized subvastus approach. J Arthroplasty. 2006 Jun;21(4 Suppl 1):22-6. doi: 10.1016/j.arth.2006.02.081.
12. Roysam GS, Oakley MJ. Subvastus approach for total knee arthroplasty: a prospective, randomized, and observer-blinded trial. J Arthroplasty. 2001 Jun;16(4):454-7. doi: 10.1054/arth.2001.22388.
13. Schroer WC, Diesfeld PJ, Reedy ME, LeMarr AR. Mini-subvastus approach for total knee arthroplasty. J Arthroplasty. 2008 Jan;23(1):19-25. doi: 10.1016/j.arth.2006.12.100.
14. Tenholder M, Clarke HD, Scuderi GR. Minimal-incision total knee arthroplasty: the early clinical experience. Clin Orthop Relat Res. 2005 Nov;440:67-76. doi: 10.1097/01.blo.0000185450.89364.10.
15. Aglietti P, Baldini A, Sensi L. Quadriceps-sparing versus minisubvastus approach in total knee arthroplasty. Clin Orthop Relat Res. 2006 Nov;452:106-11. doi: 10.1097/01.blo.0000238789.51972.16.
16. Berth A, Urbach D, Neumann W, Awiszus F. Strength and voluntary activation of quadriceps femoris muscle in total knee arthroplasty with midvastus and subvastus approaches. J Arthroplasty. 2007 Jan;22(1):83-8. doi: 10.1016/j.arth.2006.02.161.
17. Sporer SM. The minimally invasive subvastus approach for primary total knee arthroplasty. J Knee Surg. 2006 Jan;19(1):58-62. doi: 10.1055/s-0030-1248080.
18. Kazarian GS, Siow MY, Chen AF, Deirmengian CA. Comparison of Quadriceps-Sparing and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. J Arthroplasty. 2018 Jan;33(1):277-283. doi: 10.1016/j.arth.2017.08.025.
19. St Mart JP, Goh EL. The current state of robotics in total knee arthroplasty. EFORT Open Rev. 2021 Apr 1;6(4):270-279. doi: 10.1302/2058-5241.6.200052.
20. Nogalo C., Meena, A., Abermann, E. et al. Complications and downsides of the robotic total knee arthroplasty : a systematic review. Knee Surg Sports Traumatol Arthrosc. 2023 June 18; 31: 736–750. doi: 10.1007/s00167-022-07031-1.
21. Shatrov, J., & Parker, D. (2020). Computer and robotic—assisted total knee arthroplasty : A review of outcomes. Journal of Experimental Orthopaedics. 2020 Sep 24; 7(1), 70. doi: 10.1186/s40634-020-00278-y.
22. Sultan AA, Piuzzi N, Khlopas A, Chughtai M, Sodhi N, Mont MA. Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection. Expert Rev Med Devices. 2017 Dec;14(12):925-927. doi: 10.1080/17434440.2017.1392237.
23. Siddiqi A, Horan T, Molloy RM, Bloomfield MR, Patel PD, Piuzzi NS. A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design. EFORT Open Rev. 2021 Apr 1;6(4):252-269. doi: 10.1302/2058-5241.6.200071.
24. Chandrashekar, P., Babu, K.A., Nagaraja, H.S. et al. Intraoperative Safety of an Autonomous Robotic System for Total Knee Replacement : A Review of 500 Cases in India. JOIO. 57, 1800–1808 (2023). doi: 10.1007/s43465-023-00970-y.
25. Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, Mont MA. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Greater Accuracy and Precision to Plan Compared with Manual Techniques. J Knee Surg. 2019 Mar;32(3):239-250. doi: 10.1055/s-0038-1641729.
26. Song EK, Seon JK, Park SJ, Jung WB, Park HW, Lee GW. Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc. 2011 Jul;19(7):1069-76. doi: 10.1007/s00167-011-1400-9.
27. Li J, Yan Z, Lv Y, Li Y, Ye P, Deng P, Zhang H, Chen J, Li J, Qi X, Zeng J, Zeng Y, Feng W. Impact of intraoperative medial collateral ligament injury on outcomes after total knee arthroplasty : a meta-analysis and systematic review. J Orthop Surg Res. 2021 Nov 20;16(1):686. doi: 10.1186/s13018-021-02824-5.
28. Kim K, Kim YH, Park WM, Rhyu KH. Stress concentration near pin holes associated with fracture risk after computer navigated total knee arthroplasty. Comput Aided Surg. 2010;15(4-6):98-103. doi: 10.3109/10929088.2010.515419.
Review
For citations:
Pimanchev O.V., Nebelas R.P., Ryapolov Yu.V., Gavriliuk V.V., Romanov D.A. Subvastus approach in robotic total knee arthroplasty. Department of Traumatology and Orthopaedics. 2026;(1):30-38. (In Russ.) https://doi.org/10/17238/issn2226-2016.2026.1.30-38
Views:
137
JATS XML
Email this article 