Does The Minimally Invasive Quadriceps Sparing Approach Provide Better Short Term Recovery Than The Medial Parapatellar Approach In Primary Total Knee Arthroplasty?

Abstract

The median parapatellar (MPP) approach is commonly utilised for total knee arthroplasty (TKA). There is an increasing trend towards enhanced recovery and shorter length of hospital stays. It is suggested that the minimally invasive quadriceps sparing (MIQS) TKA can provide both a shorter incision and, by minimizing soft tissue disruption, a quicker recovery. Being technically more demanding the MIQS approach has the potential for increased early complication rates. We performed a systematic review and meta analysis comparing MPP vs MIQS TKA.Methods: A systematic literature search was performed with only randomised controlled studiesincluded for analysis. Data reported on incision length, knee flexion, straight leg raise,component positioning, knee society scores and post-operative complications were analysed.Results: Nine studies were included: 342 patients in the MIQS group and 351 in the MPP group. There were statistically significant differences between the groups in terms of operative time, incision length and ability to straight leg raise within the first week. There were more outliers for tibial and femoral component positioning in the MIQS group. There was also a higher complication rate in the MIQS group. There was no statistically significant difference in post-operative functional score. Conclusion:MIQS TKR allows shorter incision and earlier straight leg raise. This analysis raises concerns regarding the rate of complications, particularly component malpositioning, compared with MPP TKA. Over our relatively short term follow up this did not present a statistically significant difference in terms of overall outcome; longer term follow-up is needed to assess this.