Porównanie dostępu podrzepkowego i przyśrodkowego okołorzepkowego w całkowitej alloplastyce stawu kolanowego u pacjentów powyżej 75. roku życia: implikacje dla rehabilitacji pooperacyjnej i wczesnego uruchamiania

BACKGROUND Total knee arthroplasty (TKA) is increasingly performed in older patients to manage severe osteoarthritis. Given the aging population, optimizing surgical techniques for this age group has become increasingly important. The surgical approach impacts postoperative outcomes, particularly in patients aged 75 years and over, who are prone to immobilization-related complications. This study compared the subvastus (SV) and medial parapatellar (MP) approaches, focusing on rehabilitation, early mobilization, and complications. MATERIAL AND METHODS A retrospective trial included 60 patients aged over 75 years with stage IV osteoarthritis, undergoing TKA. Patients were divided into SV or MP approaches. Outcomes included time to straight leg raise (SLR), range of motion (ROM), pain (visual analog scale, VAS), length of hospital stay, and complications. RESULTS The SV group achieved earlier SLR (1.7 vs 3.4 days, P=0.001), better ROM at 1 week (94° vs 79°, P=0.008), lower VAS scores at day 3 (4.0 vs 6.0, P=0.02), and shorter hospital stay (5.0 vs 6.7 days, P=0.03). Blood loss was slightly higher in the SV group (360.5 vs 340.2 mL, P=0.76). Immobilization-related complications were lower in the SV group (3.3% vs 10%, P=0.24). CONCLUSIONS The SV approach enhanced early mobilization and rehabilitation in older patients, potentially reducing immobilization-related complications, despite slightly higher blood loss. These findings suggest that the subvastus approach may be preferable in geriatric patients to enhance recovery outcomes.