Better outcomes after mini-subvastus approach for primary total knee arthroplasty: a Bayesian network meta-analysis

Abstract

Introduction Alternatives to the classical medial parapatellar (MPP) approach for total knee arthroplasty (TKA) include the mini-medial parapatellar (MMPP), mini-subvastus (MSV), mini-midvastus (MMV) and quadriceps-sparing (QS) approaches. The best approach has been not fully clarified. The purpose of the present study was to conduct a Bayesian network meta-analysis comparing these approaches. Materials and methods The present analysis was carried out according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. The databases search was performed in October 2019. All clinical trials comparing two or more approaches for primary TKA were considered for inclusion. The baseline comparability was evaluated through the analysis of variance (ANOVA) test. The statistical analysis was performed through the STATA software/MP. A Bayesian hierarchical random-effects model analysis was adopted in all the comparisons. Results Data from 52 articles (4533 patients) were collected. The mean follow-up was 20.38 months. With regard to diagnosis, gender, age and BMI, adequate baseline comparability was detected. The MSV approach ranked better concerning clinical scores (the lowest visual analogic scale, the higher KSS and KSFS) and functional outcomes (the shortest straight leg raise, the greatest degree of flexion and range of motion). Concerning perioperative data, the MSV evidenced the shortest hospital stay, while the MPP the shortest surgical duration and lowest estimated blood loss. Conclusion According to the main findings of the present study, the mini-subvastus approach for total knee arthroplasty demonstrated superior overall compared to the other approaches. Orthopaedic surgeons should consider this approach in the light of the evidence and limitations of this Bayesian network meta-analysis.

Comparing the Sub-Vastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Meta-Analysis of Short-Term Outcomes

“…A number of systematic reviews and meta-analyses have investigated the relationship between the SV and MPP approaches [15, [44][45][46][47][48][49][50][51] with some having similar trends to our study. However, the majority of those studies yielded less than 15 RCTs [15,[44][45][46][47][48][49]51] with only one study [50] reporting on 20 RCTs.…”

No difference between mobile and fixed bearing in primary total knee arthroplasty: a meta-analysis

“…Moreover, the surgical approach may influence the clinical outcomes. A recent network meta-analysis demonstrated that the mini-subvastus approach outperformed all other approaches (mini-medial parapatellar, midvastus, quadriceps sparring) [ 77 ]. Patellar retaining or resurfacing has not been investigated, and may represent a further limitation [ 80 ].…”

NSAIDs for Prophylaxis for Heterotopic Ossification After Total Hip Arthroplasty: A Bayesian Network Meta-analysis

“…Funnel plots were generated to estimate the risk of publication bias by plotting the natural logarithm of an individual study effect size against the standard error of the natural logarithm of an individual study effect size. This methodology has been already used in previous studies [18][19][20][21]. A further meta-analysis comparing subgroups selective vs non-selective NSAID was performed.…”