Clinical and Radiologic Outcomes of Contemporary 3 Techniques of TKA

Abstract

This report compares the radiologic and early clinical results of total knee arthroplasty (TKA) performed by the same surgeon using 3 techniques. In this prospective study, 75 knees were randomized to conventional technique (25 knees), image-free navigation system (25 knees), or minimally invasive surgery (MIS) (25 knees). Age range of the 43 women (65 knees) and 5 men (10 knees) was 58 to 81 years. Posterior stabilized knee prosthesis was used in all patients. Data was collected according to Knee Society System for radiologic evaluation of x-rays. Knee Society clinical (KS-C) and functional knee scores were measured preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years. The postoperative KS-C was not statistically better in the MIS group (mean, 88 ± 11.5; range, 70-100) than the conventional (mean, 85.9 ± 7.8; range, 74-94) (P=.68) or navigation group (mean, 85 ± 11; range, 63-100) (P=.59). Mean postoperative delta (mechanical axis) angle was significantly different (P=.014): 2.38° in the conventional group (SD=2.88°; 95% CI, 1.19°-3.57°; range, -1.59° to 6.86°), 0.61° in the navigation group (SD=2.07°; 95% CI, -0.24° to 1.46°; range, -2.07° to 4.25°), and 4.25° in the MIS group (SD=6.52°; 95% CI, 1.56°-6.94°; range, -6.72° to 15.60°). Significant difference could be elicited between navigation-assisted and MIS groups, with navigation-assisted surgery providing more accurate alignment of the mechanical axis (P=.014). Of the three techniques, navigation-assisted surgery gives superior prosthesis alignment and promising longevity of TKA.

Comparison of the clinical and radiological outcomes of three minimally invasive techniques for total knee replacement at two years

“…Computer-assisted navigation in MIS-TKR has been shown in some series to improve the precision of implant positioning and to provide less variation in mechanical alignment than MIS-TKR alone, 14,15 which mirrors our findings. Nevertheless, we found that there were still more outliers in the NA-QS group than in the MP cohort.…”

“…13 Possibly the restricted view offered through a QS approach may be compensated for by a navigation (NA) system to improve orientation and alignment. 14,15 It might be reasonable to assume that NA-QS-TKR performed by an experienced surgeon could provide optimal early recovery achieving the desired mechanical axis with a lower proportion of prosthetic alignment outliers. There are few studies comparing the outcomes of QS and other MIS-TKR approaches, and the results remain controversial.…”

Clinical Outcomes After Computer-assisted Versus Conventional Total Knee Arthroplasty

“…Among these patients, 1376 were randomly allocated to the computer-assisted TKA group and 1282 to the conven-tional TKA group. Two included trials 25,30 had 3 groups (1 with computer-assisted TKA, 1 with minimally invasive surgery, and 1 with conventional TKA). In the current meta-analysis, computer-assisted TKA and conventional TKA were included.…”

“…*References 1,4, 6,[18][19][20]22,23,25,[32][33][34] the risk of .3° malalignment was significantly less with computer-assisted TKA than with conventional TKA for mechanical axis and frontal plane femoral and tibial component alignment. 36 The results of this meta-analysis of the tibial (OR, 0.31; 95% CI, 0.16 to 0.61) and femoral slopes (OR, 0.13; 95% CI, 0.03 to 0.54) were statistically significant (P,.05) in favor of computer-assisted TKA at .2° malalignment.…”

Comparisons among three approaches—two minimally invasive and one conventional—for total knee arthroplasty: a retrospective cohort study with minimum follow-up of 10 years

“…To date, various types of minimally invasive approaches for TKA have been developed to improve functional recovery and rehabilitation and accelerate the return to the activities of daily life [5,6]. Among them, two of the most commonly used minimally invasive procedures are the mini-medial parapatellar (MMP) and quadriceps-sparing (QS) approaches [7][8][9]. Some investigators have indicated that minimally invasive approaches may compromise the advantages of correct osteotomy, proper ligament balance and good prosthesis position to achieve potentially rapid rehabilitation [10][11][12], potentially sacrificing the long-term clinical outcomes and survival of the prostheses [13][14][15][16].…”