Minimally Invasive Midvastus versus Standard Parapatellar Approach in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Xu, Sanzhong; Lin, Xiang; Xiang, Tong; Wang, Xuan-Wei

doi:10.1371/journal.pone.0095311

Cited by 29 publications

(31 citation statements)

References 32 publications

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“…However, no difference was found between the two groups postoperative values. Similar results are shown in the most publications included meta-analyses [ 24 , 28 , 32 , 34 , 37 – 40 , 42 ].…”

Section: Discussionsupporting

confidence: 88%

“…There is no agreement in previous studies in term of blood loss. Some authors reported significant less blood loss [ 10 , 11 , 32 , 41 , 43 , 44 ] in favor of the minimally invasive approach, while others did not find any differences between techniques [ 28 , 34 , 37 – 39 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies did not find statistical significant differences in pain, range of movement (ROM), Quadriceps strength, Knee Society Score (KSS) [ 37 – 40 ]. The results of meta-analyses are conflicting [ 28 , 36 , 41 – 45 ].…”

Section: Introductionmentioning

confidence: 99%

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Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique

Feczko

Engelmann

Arts

et al. 2016

BMC Musculoskelet Disord

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BackgroundDespite the growing evidence in the literature there is still a lack of consensus regarding the use of minimally invasive surgical technique (MIS) in total knee arthroplasty (TKA).MethodsA prospective, randomized, international multicentre trial including 69 patients was performed to compare computer-assisted TKA (CAS-TKA) using either mini-midvastus (MIS group) or standard medial parapatellar approach (conventional group).Patients from 3 centers (Maastricht, Zwickau, Adelaide) with end-stage osteoarthritis of the knee were randomized to either an MIS group with dedicated instrumentation or a conventional group to receive cruciate retaining CAS-TKA without patella resurfacing. The primary outcome was to compare post operative pain and range of motion (ROM). The secondary outcome was to measure the duration of surgery, blood loss, chair rise test, quadriceps strength, anterior knee pain, Knee Society Score (KSS),WOMAC scores, mechanical leg axis and component alignment.ResultsPatients in the MIS group (3.97 ± 2.16) had significant more pain at 2 weeks than patients in the conventional group (2.77 ± 1.43) p = 0.003. There was no significant difference in any of the other primary outcome parameters. Surgery time was significantly longer (p < 0.001) and there were significantly higher blood loss (p = 0.002) in the MIS group as compared to the conventional group. The difference of the mean mechanical leg alignment between the groups was not statistically significant (–0.43° (95 % CI –1.50 – 0.64); p = 0.43).There was no significant difference of component alignment between the two surgical groups with respect to flexion/extension (p = 0.269), varus/valgus (p = 0.653) or rotational alignment (p = 0.485) of the femur component and varus valgus alignment (p = 0.778) or posterior slope (p = 0.164) of the tibial component.ConclusionThere was no advantage of the MIS approach compared to a conventional approach CAS-TKA in any of the primary outcome measurements assessed, however the MIS approach was associated with longer surgical time and greater blood loss. MIS-TKA in combination with computer navigation is safe in terms of implant positioning.Trial registration numberClinicalTrials.gov NCT02625311 8 December 2015

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique

Feczko

Engelmann

Arts

et al. 2016

BMC Musculoskelet Disord

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show abstract

“…TKA without patella eversion and anterior translation of the tibia is well known as the minimally invasive technique. Proponents of the minimally invasive technique claim that these techniques will result in an earlier recovery of range of motion, an earlier discharge from the hospital, and less pain compared with the conventional TKA without any complications including the wound problems [ 13 ]. Dalury et al indicated that patellar eversion and anterior tibial translation could have no adverse effects on the range of motion, quadriceps strength, or patient’s knee preference during the early postoperative recovery period after TKA [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

What are the important surgical factors affecting the wound healing after primary total knee arthroplasty?

et al. 2016

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BackgroundWound condition after primary total knee arthroplasty (TKA) is an important issue to avoid any postoperative adverse events. Our purpose was to investigate and to clarify the important surgical factors affecting wound score after TKA.MethodsA total of 139 knees in 128 patients (mean 73 years) without severe comorbidity were enrolled in the present study. All primary unilateral or bilateral TKAs were done using the same skin incision line, measured resection technique, and wound closure technique using unidirectional barbed suture. In terms of the wound healing, Hollander Wound Evaluation Score (HWES) was assessed on postoperative day 14. We performed multiple regression analysis using stepwise method to identify the factors affecting HWES. Variables considered in the analysis were age, sex, body mass index (kg/m2), HbA1C (%), femorotibial angle (degrees) on plain radiographs, intraoperative patella eversion during the cutting phase of the femur and the tibia in knee flexion, intraoperative anterior translation of the tibia, patella resurfacing, surgical time (min), tourniquet time (min), length of skin incision (cm), postoperative drainage (ml), patellar height on postoperative lateral radiographs, and HWES. HWES was treated as a dependent variable, and others were as independent variables.ResultsThe average HWES was 5.0 ± 0.8 point. According to stepwise forward regression test, patella eversion during the cutting phase of the femur and the tibia in knee flexion and anterior translation of the tibia were entered in this model, while other factors were not entered. Standardized partial regression coefficient was as follows: 0.57 in anterior translation of the tibia and 0.38 in patella eversion.ConclusionsFortunately, in the present study using the unidirectional barbed suture, major wound healing problem did not occur. As to the surgical technique, intraoperative patella eversion and anterior translation of the tibia should be avoided for quality cosmesis in primary TKA.

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“…However, no difference regarding VAS score, KOOS, OKS, KSS were depicted by the study. Some studies found out differences only in the short-term followup (1)(2)(3)(4)(5). The authors concluded that midvastus approach was not superior to conventional approach for primary knee arthroplasty.…”

Section: The Study Entitled "Comparison Of Mini-midvastus and Conventmentioning

confidence: 99%

Less invasive approach in knee arthroplasty: everybody on board?

2016

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Minimally Invasive Midvastus versus Standard Parapatellar Approach in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Cited by 29 publications

References 32 publications

Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique

Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique

What are the important surgical factors affecting the wound healing after primary total knee arthroplasty?

Less invasive approach in knee arthroplasty: everybody on board?

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