Early Patient Outcomes After Primary Total Knee Arthroplasty with Quadriceps-Sparing Subvastus and Medial Parapatellar Techniques

Tomek, Ivan M.; Kantor, Stephen; Cori, LuAnne A; Scoville, Jennifer M; Grove, Margaret R.; Morgan, Tamara S.; Swarup, Ishaan; Moschetti, Wayne E.; Spratt, Kevin F.

doi:10.2106/jbjs.l.01578

Cited by 25 publications

(16 citation statements)

References 25 publications

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“…After screening in duplicate, 20 RCTs published between 1991 and 2016 involving 1893 knee replacements in 1694 patients were included in this review. 20 - 39 The progress of articles through this review is summarized as a flow diagram in Figure 1 . The number of study participants ranged from 20 22, 36 to 231.…”

Section: Resultsmentioning

confidence: 99%

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: Resultsmentioning

confidence: 99%

Medial subvastus versus the medial parapatellar approach for total knee replacement

et al. 2018

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“…after retrospectively or at best prospectively compared cohorts (age/sex matched), MIS approaches seemed to fail to confer a substantial postoperative advantage in regard to some early outcomes such as hospital stay, VAS, KSS and straight leg raise [7,27,28]. This was confirmed by several other recent RCTs [29,30] and RCT meta-analyses [6,15,[31][32][33].…”

Section: Discussionmentioning

confidence: 79%

Comparison of minimally invasive approaches and standard median parapatellar approach for total knee arthroplasty: A systematic review and network meta-analysis of randomized controlled trials

Zhang

Rüwald

et al. 2021

THC

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BACKGROUND: Minimally invasive total knee arthroplasty (TKA) has been actively advertised by the orthopedic industry. The purpose of this network meta-analysis was to comprehensively compare the effectiveness of four minimally invasive surgery (MIS) approaches and the medial parapatellar (MPP) approach to improve the American Knee Society Score (KSS) in primary TKA. MATERIALS AND METHODS: Studies were comprehensively searched on PubMed, Embase, Cochrane Library (CENTRAL), Web of Science and Science Direct up to June 2018 with a major focus on the outcome of KSS. Risk of bias was assessed using the Cochrane risk of bias tool. Quality assessment was performed using the GRADE system. Both pair-wise and network meta-analyses are calculated to comprehensively compare the effectiveness of four MIS and TKA approaches. RESULTS: Eleven trials with 1025 knees undergoing TKA were included. Our analysis showed that both MPP and MIS approaches provided improvement in terms of short-term (four-eight weeks) total, objective and functional KSS score. The network-meta analysis revealed that MIS approaches showed a trend towards superior KSS improvement over standard MPP approaches. However, statistical advantages were only observed in the mini-MPP group for functional KSS scores when compared with conventional MPP and quadriceps-sparing (QS) group. CONCLUSIONS: Evidence shows that MIS TKA approaches are effective alternatives to MPP approaches. However, orthopedic surgeons should be cautiously optimistic about minimally invasive TKA in terms of KSS improvement.

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“…This was further reduced to 9 studies for inclusion in the meta-analysis; Figure 3 shows the study selection flow according to PRISMA guidelines. Tomek et al Yang et al and Tasker et al studies are excluded in this meta-analysis [16][17][18]. In the Tomek study the MIQS approach was actually the subvastus approach, in the Yang et al study it was midvastus and in the Tasker study the authors mentioned the Bristol quadricepssparing approach initially; however, the approach in fact was either a subvastus or a midvastus approach [19][20][21][22][23].…”

Section: Resultsmentioning

confidence: 99%

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

Taute¹

2018

OPROJ

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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.

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Early Patient Outcomes After Primary Total Knee Arthroplasty with Quadriceps-Sparing Subvastus and Medial Parapatellar Techniques

Cited by 25 publications

References 25 publications

Medial subvastus versus the medial parapatellar approach for total knee replacement

Medial subvastus versus the medial parapatellar approach for total knee replacement

Comparison of minimally invasive approaches and standard median parapatellar approach for total knee arthroplasty: A systematic review and network meta-analysis of randomized controlled trials

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

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