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The Subvastus Approach to Knee Replacement


Boyd W. Haynes III, MD

Orthopaedic surgeries evolve with the advancement of technology, surgical instrumentation, surgical technique, and pain management. The knee replacement is no different and has been through many iterations of approaches, implant types, differing implant material composition, etc., all with the goal of delivering the best patient outcome and the most highly performing prosthesis.  In this article, I will discuss the subvastus approach to knee replacement (being marketed under other names in Hampton Roads) and highlight why it is my choice for my patients who need knee replacement.

Knee replacement surgery is a major procedure that typically involves shaving both the femur and the tibia to remove the knee joint, cutting the quadriceps muscle, detaching, or cutting tendons, ligaments, and other soft tissues so that the knee prosthesis can be put into place.  After surgery, not only do the bones/ new joint have to heal, but so do all those other soft tissue traumas, which can be very painful and take quite a while to mend.

The subvastus approach is not new and has been around for decades.  Just like the Jiffy Hip, surgical approaches sometimes don’t catch on for a while due to a lack of technology, the technique not being perfected or the procedure taking too much time.  The subvastus approach does require a surgeon with an advanced skill level and the surgery does take longer than a traditional knee replacement surgery.  This should be considered and discussed with your surgeon.

The subvastus approach is different in that it is substantially tissue-sparing in relation to the traditional surgical approach for knee replacement.  Neither the quadriceps muscle nor the tendon is cut, which spares the patient a great deal of pain and time in rehabilitation after surgery.  Much care is also taken by the surgeon to leave as many tendons and ligaments intact as possible, as well as minimizing trauma to other soft tissues.  Yes, the femur and the tibia are cut, the knee joint is removed and replaced with a prosthetic implant.  However, because the soft tissues (specifically quadriceps tendon and muscle are spared), patients experience the following benefits:

  • Less post-operative swelling and bruising
  • Less post-operative pain
  • Easier post-operative rehabilitation
  • Faster return to unassisted walking and daily activities
  • Shorter recovery period
  • Quicker return to driving and work

If you’re considering knee replacement, several of the Orthopaedic physicians at OSC perform the subvastus approach and can help you understand if this approach is right for you.

Make an appointment with Dr. Haynes or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900. Our office is located in Newport News, VA. We are 40 minutes from Virginia Beach and an hour from Richmond, VA.

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