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National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Use the PICO framework to formulate a specific clinical question.
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Formulate a search strategy.
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Prospectively register the review protocol.
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Execute the literature search.
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Apply eligibility criteria to exclude irrelevant studies.
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Extract data and appraise each study for risk of bias and external validity.
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Provide a narrative review.
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If appropriate data are available, perform a meta-analysis.
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Report the review findings in the context of the risk of bias assessment, any sensitivity analyses and the analysis of risk of publication bias.
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Useful resources include the Cochrane Handbook, PROSPERO, GRADE and PRISMA.
Cite this article: EFORT Open Rev 2019;4:213-220. DOI: 10.1302/2058-5241.4.180049
Search for other papers by James R. Berstock in
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Twenty randomized controlled trials comprising 1893 primary total knee replacements were included in this review.
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The subvastus approach conferred superior results for mean difference (MD) in time to regain an active straight leg raise (1.7 days, 95% confidence interval [CI] 1.0 to 2.3), visual analogue score for pain on day one (0.8 points on a scale out of 10, 95% CI 0.2 to 1.4) and total range of knee movement at one week (7°, 95% CI 3.2 to 10.7). The subvastus approach also resulted in fewer lateral releases (odds ratio 0.4, 95% CI 0.2 to 0.7) and less peri-operative blood loss (MD 57 mL, 95% CI 10.5 to 106.4) but prolonged surgical times (MD 9.7 min, 95% CI 3.9 to 15.6).
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There was no difference in Knee Society Score at six weeks or one year, or the rate of adverse events including superficial or deep infection, deep vein thrombosis or knee stiffness requiring manipulation under anaesthesia.
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This review demonstrates evidence of early post-operative benefits following the subvastus approach with equivalence between approaches thereafter.
Cite this article: EFORT Open Rev 2018;3:78-84. DOI: 10.1302/2058-5241.3.170030.
