Surgical Approaches in Primary and Revision Total Knee Arthroplasty: A Contemporary Narrative Review
Abstract: Background: Surgical exposure in total knee arthroplasty (TKA) must reconcile preservation of the extensor mechanism with visualization, ligament balancing, accurate implantation, and reliable closure. Numerous standard, muscle-sparing, lateral, and extensile approaches are available, but terminology and evidence quality vary considerably. Methods: This narrative review used targeted web-assisted searches of PubMed-indexed publications, PubMed Central, and journal websites, supplemented by reference tracing. Landmark technical and comparative studies were considered alongside publications available through 7 October 2026. Primary and revision procedures were assessed separately. No exhaustive database screening, formal risk-of-bias assessment, or quantitative pooling was performed. Findings: Medial parapatellar exposure remains a versatile reference approach. Subvastus and midvastus techniques can improve selected early recovery outcomes, although sustained functional advantages are inconsistent. Restricted quadriceps-sparing exposure has a distinct learning curve and historical concerns about component-position outliers. Lateral parapatellar exposure is anatomically attractive in selected valgus knees; lateral subvastus variants remain less extensively validated. A 2026 review of 27 randomized trials found no approach consistently superior across range of motion, patient-reported outcomes, and reoperation. Recent observational studies support early subvastus recovery benefits but cannot establish causal superiority. In revision TKA, quadriceps snip and tibial tubercle osteotomy provide different solutions to restricted exposure; V?Y quadricepsplasty and other salvage exposures require more selective use and repair-specific rehabilitation. Conclusions: Approach selection should follow deformity, tissue mobility, previous surgery, required reconstruction, and surgeon expertise. A limited exposure should be enlarged whenever visualization or tissue safety becomes inadequate. Contemporary evidence supports individualized selection rather than a universal preferred approach. Future trials should separate exposure from perioperative care and robotic technology, measure clinically important early function, and capture uncommon complications and long-term revision.
Keywords: total knee arthroplasty; surgical approach; subvastus; midvastus; lateral approach; quadriceps snip; tibial tubercle osteotomy; revision arthroplasty
How to Cite?: Nishant, "Surgical Approaches in Primary and Revision Total Knee Arthroplasty: A Contemporary Narrative Review", Volume 15 Issue 10, October 2026, International Journal of Science and Research (IJSR), Pages: 481-490, https://www.ijsr.net/getabstract.php?paperid=SR261007084432, DOI: https://dx.doi.org/10.21275/SR261007084432