Clinical outcome and rate of complications after primary total knee replacement performed with quadriceps-sparing or standard arthrotomy

Abstract

We performed a prospective, randomised study to compare the results and rates of complications of primary total knee replacement performed using a quadriceps-sparing technique or a standard arthrotomy in 120 patients who had bilateral total knee replacements carried out under the same anaesthetic. The clinical results, pain scales, surgical and hospital data, post-operative complications and radiological results were compared. No significant differences were found between the two groups with respect to the blood loss, knee score, function score, pain scale, range of movement or radiological findings. In contrast, the operating time (p = 0.0001) and the tourniquet time (p < 0.0001) were significantly longer in the quadriceps-sparing group, as was the rate of complications (p = 0.0468). We therefore recommend the use of a standard arthrotomy with the shortest possible skin incision for total knee replacement.

Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?

“…Although there are adequate data to corroborate the importance of accurate femoral component alignment in the coronal plane [9,31,32,38], we are not aware of equally strong evidence concerning sagittal orientation of the femoral component. We found prolonged tourniquet and operating times for MIS TKAs, which is in agreement with other publications [11,24,25,27,37]. Therefore, we assume that the published risks and disadvantages of a tourniquet [3,28,34,42,43] could be more pronounced for MIS TKA.…”

“…reported as improved in the long term [4,11,21], improved only in the short term [15,18,27], or similar [24,25,30,37]. The same has been observed with respect to radiographic findings (leg alignment and/or component alignment).…”

Does Minimally Invasive Surgery Improve Short-term Recovery in Total Knee Arthroplasty?

“…However, some of the included randomized trials did not adequately describe quality items (eg, mode of randomization, blinding, allocation concealment) that often are used for assessment of overall trial quality. The method of random sequence generation in five studies included computers and tables [8,15,20,21,25]. The method of concealment reportedly was sealed envelopes in five studies [8,19,20,27,31].…”

“…Chin et al [8] Karpman & Smith [21] Kim et al [25] Shen et al [39] Subtotal (95% CI) Total events Heterogeneity: Tau² = 0.00; Chi² = 1.87, df = 3 (P = 0.60); I² = 0% Test for overall effect: Z = 1.72 (P = 0.08)…”

“…One study defined MIS TKA as an approach that was less damaging to the extensor mechanism and avoided eversion of the patella [20]. Several MIS TKA techniques have been described: traditional mini (mini-medial parapatellar [15], mini-midvastus [20,21], mini-subvastus [22,43]) and fully innovative techniques (quad-sparing) [25,39,48]. Advocates of MIS TKA commonly suggest it allows patients faster recovery time [9,15], less blood loss [20], decreased soft tissue trauma [30,37], more pain relief [18], better cosmetic appearance [15,18,26], and measurable improvement of function [9,15,48].…”