Minimally invasive surgery did not improve outcome compared to conventional surgery following unicompartmental knee arthroplasty using local infiltration analgesia

Abstract

Background and purpose There has recently been interest in the advantages of minimally invasive surgery (MIS) over conventional surgery, and on local infiltration analgesia (LIA) during knee arthroplasty. In this randomized controlled trial, we investigated whether MIS would result in earlier home-readiness and reduced postoperative pain compared to conventional unicompartmental knee arthroplasty (UKA) where both groups received LIA.Patients and methods 40 patients scheduled for UKA were randomized to a MIS group or a conventional surgery (CON) group. Both groups received LIA with a mixture of ropivacaine, ketorolac, and epinephrine given intra- and postoperatively. The primary endpoint was home-readiness (time to fulfillment of discharge criteria). The patients were followed for 6 months.Results We found no statistically significant difference in home-readiness between the MIS group (median (range) 24 (21–71) hours) and the CON group (24 (21–46) hours). No statistically significant differences between the groups were found in the secondary endpoints pain intensity, morphine consumption, knee function, hospital stay, patient satisfaction, Oxford knee score, and EQ-5D. The side effects were also similar in the two groups, except for a higher incidence of nausea on the second postoperative day in the MIS group.Interpretation Minimally invasive surgery did not improve outcome after unicompartmental knee arthroplasty compared to conventional surgery, when both groups received local infiltration analgesia. The surgical approach (MIS or conventional surgery) should be selected according to the surgeon’s preferences and local hospital policies.ClinicalTrials.gov. (Identifier NCT00991445).

Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches

“…The assessments focused on functional outcome measures during the recovery from knee replacement in the first six months. We did not attempt to compare pain medication levels in the two groups which has been the subject of previous studies [ 18 , 19 ] investigating the effects of surgical approach.…”

Comparisons of the Efficacy and Safety of Total Knee Arthroplasty by Different Surgical Approaches: A Systematic Review and Network Meta‐analysis

“…A total of 1678 relevant studies were obtained in the initial search of the PubMed (n = 190), EMBASE (n = 477), Cochrane Library (n = 531), and Web of Science (n = 460) databases, as well as from manual retrieval (n = 20). After excluding duplicate literature and applying the inclusion criteria and exclusion criteria, 51 RCTs 15, were finally included in this study, of which 42 15,[29][30][31][32][33][34][35][36][37][39][40][41][42][43][44][45][46][47][49][50][51][52][53][54][55][56][57][58][59][62][63][65][66][67][70][71][72][73][74][75][76] were clearly approved by ethics committees, while the approval of nine was not reported. Two three-arm tests were included in the analysis, while the remainder were all two-arm tests.…”

Continuous Adductor Canal Block used for postoperative pain relief after medial Unicondylar Knee Arthroplasty: a randomized, double-blind, placebo-controlled trial

“…In this study, the mean surgical incision in both groups was over 12 cm long, similar to conventional surgery. However, it has been reported that even with minimally invasive surgery of UKA (an 8 to 10 cm-long medial parapatellar skin incision), pain scores and functional outcomes were not improve by using LIA alone [37]. Considering the surgical area of nerve innervation in medial UKA, continuous ACB may be uniquely suited to provide postoperative analgesia.…”