Minimally Invasive Subvastus Approach: Improving the Results of Total Knee Arthroplasty: A Prospective, Randomized Trial

Abstract

Background Minimally invasive knee arthroplasty seeks to diminish the problems of traditional extensile exposures aiming for more rapid rehabilitation of patients after surgery. Questions/purposesTo determine if the subvastus approach results in less perioperative pain and blood loss, shorter hospital stay, and improved function at both early and long-term followup.Methods One hundred patients were enrolled in a prospective, randomized trial. Fifty were operated on using a minimally invasive subvastus approach and the other 50 by a conventional, peripatellar approach. Minimum followup was 3 years. A repeated-measures analysis of variance was used to compare the Knee Society score and range of motion during followup. ResultsThe minimally invasive approach resulted in greater perioperative bleeding but no increase in transfusions. No differences were found in postoperative pain between groups nor did hospital stay show any differences.

A prospective randomised study of minimally invasive midvastus total knee arthroplasty compared with standard total knee arthroplasty

“…Although pioneers of this technique have reported excellent results, the longest mean follow up of a randomised control trial (RCT) in the literature is 36 months; clearly longer term results are awaited [38]. Much contemporary data come from health care systems where less invasive operative techniques may have been carried out on self-selecting, private patients.…”

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

“…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].…”

Comparison of Mini-Midvastus and Conventional Total Knee Arthroplasty with Clinical and Radiographic Evaluation

“…In contrast to these positive findings, some recently published and well-designed studies [12][13][14][15][16] and 2 meta-analyses 17,18 have indicated that minimally invasive total knee arthroplasty could also have important shortcomings, such as prolonged operative time, an increased number of wound complications, and more malpositioning of the prosthesis. However, these randomized clinical trials had relatively short-term follow-up and had neither patient-reported outcomes nor radiographic evaluations.…”