Table 1.

Comparative table depicting the advantages and disadvantages of all the approaches to the knee for arthroplasty.

Surgical approach	Pros	Cons
Medial parapatella	• Excellent exposures to the knee joint • Extensile • Relatively easy to safely execute • Ideal for patients with previous scars, obesity, undergoing revision TKRs, and severe deformities.	• Patellar dislocation, subluxation, stress fractures • Fragmentation of the patella secondary to avascular necrosis
Subvastus approach	• More “anatomical” approach • Extensor mechanism and the majority of medial vessels supplying the patella intact • Reduced blood loss, Lower opiate consumption • Patients exhibit earlier straight leg raise, better knee flexion, and earlier recovery process. • Compared with the medial parapatellar approach, patellar tracking was significantly improved in the subvastus group • Hamstring to quadriceps ratio reached normal levels sooner	• Difficulty with exposure and greater difficulty everting the patella • Risk of neurovascular damage in ‘Hunters canal’ • Ideal mainly for thin patient with mobile soft tissue
Midvastus approach	• Less Difficulty with exposure and everting the patella than with the subvastus approach • Less blood loss and fewer intraoperative lateral releases compared to medial parapatella	• Electromyographic abnormalities in vastus medialis • No differences in range of motion, straight leg raise, requirement for lateral releases, and functional outcome compared to medial parapatella
Trivector-retaining approach	• ?? Possibility of earlier recovery of quadriceps function	• Compromises some of the medial vessels supplying the patella • Increased blood loss • Increased consumption of opiate • Disruption of the quadriceps mechanism
Lateral approach	• Contracted lateral soft tissues can be approached directly while preserving the medial patellar blood supply • Considered for fixed valgus deformities that are isolated or combined with flexion contracture or external tibial rotation • Lower incidence of patellar maltracking	• More technically demanding • Fixed varus deformity is a relative contraindication
Minimal invasive total knee arthroplasty	• Smaller incision with less esthetic impact • Less soft tissue violation (capsule, tendon, and muscle structures) and faster postoperative recovery • Retraction rather than eversion of the patella • Reduced intraoperative blood loss • Shorter hospital stays • Intact quadriceps function and knee stability. • Greater patient satisfaction	• Obesity and poor bone stock are relative contraindications. • Development still in evolution (surgical precision, long-term fuctional outcome unclear) • Steep learning curve • Cost implications (Expensive)