Comparison of the quadriceps-sparing and subvastus approaches versus the standard parapatellar approach in total knee arthroplasty: a meta-analysis of randomized controlled trials

Peng, Xiaochun; Zhang, Xianlong; Cheng, Tao; Cheng, Mengqi; Wang, Jiaxing

doi:10.1186/s12891-015-0783-z

Cited by 25 publications

(36 citation statements)

References 38 publications

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“…Other meta-analyses have compared the medial parapatellar approach with a combination of quadriceps sparing approaches (midvastus, subvastus and mini-midvastus approaches). 9 - 12 The advantage of our review is that we have confined the comparison to that of the subvastus and medial parapatellar approaches alone, facilitating clearer surgical decision-making.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reviews of this topic have compared the medial parapatellar approach with a combination of the quadriceps sparing approaches (midvastus, mini-midvastus and subvastus together). 9 - 14 The aim of this study was to use meta-analytical methods to pool functional outcomes and adverse events from trials of the subvastus and medial parapatellar approaches to TKR exclusively.…”

Section: Introductionmentioning

confidence: 99%

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Medial subvastus versus the medial parapatellar approach for total knee replacement

et al. 2018

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Twenty randomized controlled trials comprising 1893 primary total knee replacements were included in this review.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).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.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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medial subvastus versus the medial parapatellar approach for total knee replacement

et al. 2018

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“…However, results are still not conclusive. In general, MIS approaches appear to give better earlier flexion and/or range of motion [ 52 – 58 ] although not for all MIS approaches [ 52 , 53 ]. The majority showed earlier straight leg raise [ 52 , 53 , 55 ] but not all [ 54 ].…”

Section: Compare Conventional Surgical Technique Vs Mismentioning

confidence: 99%

“…In general, MIS approaches appear to give better earlier flexion and/or range of motion [ 52 – 58 ] although not for all MIS approaches [ 52 , 53 ]. The majority showed earlier straight leg raise [ 52 , 53 , 55 ] but not all [ 54 ]. MIS appears to improve immediate post-operative pain scores [ 52 , 54 ] and early KSS [ 52 , 53 , 57 ] although one analysis found no difference in KSS [ 54 ].…”

Section: Compare Conventional Surgical Technique Vs Mismentioning

confidence: 99%

“…The majority showed earlier straight leg raise [ 52 , 53 , 55 ] but not all [ 54 ]. MIS appears to improve immediate post-operative pain scores [ 52 , 54 ] and early KSS [ 52 , 53 , 57 ] although one analysis found no difference in KSS [ 54 ]. Based on the current meta-analyses [ 52 – 58 ] there are conflicting results for blood loss, LoS, wound problems and peri-operative complications between MIS and standard approaches, so it is still not easy to draw conclusions.…”

Section: Compare Conventional Surgical Technique Vs Mismentioning

confidence: 99%

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Minimally invasive total knee replacement: techniques and results

Picard

Deakin

Balasubramanian

et al. 2018

Eur J Orthop Surg Traumatol

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In this review, we outlined the definition of minimally invasive surgery (MIS) in total knee replacement (TKR) and described the different surgical approaches reported in the literature. Afterwards, we went through the most recent studies assessing MIS TKR. Next, we searched for potential limitations of MIS knee replacement and tried to answer the following questions: Are there selective criteria and specific patient selection for MIS knee surgery? If there are, then what are they? After all, a discussion and conclusion completed this article. There is certainly room for MIS or at least less invasive surgery for appropriate selected patients. Nonetheless, there are differences between approaches. Mini-medial parapatellar is easy to master, quick to perform and potentially extendable, whereas mini-subvastus and mini-midvastus are trickier and require more caution related to risk of haematoma and vastus medialis oblique (VMO) nerve damage. Current evidence on the safety and efficacy of mini-incision surgery for TKR does not appear fully adequate for the procedure to be used without special arrangements for consent and for audit or continuing research. There is an argument that a sudden jump from standard TKR to MIS TKR, especially without computer assistance such as navigation, patient-specific instrumentation or robotic, may breach a surgeon’s duty of care towards patients because it exposes patients to unnecessary risks. As a final point, more evidence is required on the long-term safety and efficacy of this procedure which will give objective shed light on real benefits of MIS TKR.

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

Migliorini

Aretini

Driessen

et al. 2020

Eur J Orthop Surg Traumatol

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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.

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Comparison of the quadriceps-sparing and subvastus approaches versus the standard parapatellar approach in total knee arthroplasty: a meta-analysis of randomized controlled trials

Cited by 25 publications

References 38 publications

Medial subvastus versus the medial parapatellar approach for total knee replacement

Medial subvastus versus the medial parapatellar approach for total knee replacement

Minimally invasive total knee replacement: techniques and results

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

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