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A meta-analysis of minimally invasive and conventional medial parapatella approaches for primary total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Minimally invasive surgical (MIS) approaches for total knee arthroplasty (TKA) have become increasingly popular for doctors and patients. They have argued that it decreases post-operative pain, accelerates functional recovery and increases patient satisfaction due to less injury. However, critics are concerned about TKA’s possible effects on component position and with complications, considering the procedure’s limited exposure. The purpose of this study was to summarise the best evidence in comparing the clinical and radiological outcomes between MIS and a conventional approach in TKA.

Methods

Electronic databases were systematically searched to identify relevant randomised controlled trials (RCTs). Our search strategy followed the requirements of the Cochrane Library Handbook. Methodological quality was assessed, and data were extracted independently by two authors.

Results

Thirty studies, including 2,536 TKAs, were reviewed: 1,259 minimally invasive and 1,277 conventional exposure TKAs. The results showed that while the MIS group had longer operation times and tourniquet times, it had superior outcomes in KSS (objective and total), range of motion, flexion range of motion, flexion 90° day, straight leg-raising day, total blood loss and decrease in haemoglobin. However, wound-healing problems occurred more frequently in the MIS group. There were no statistically significant differences in other clinical or radiological outcomes between the MIS and conventional groups in TKA.

Conclusion

The preliminary results indicate that the MIS approach provides an alternative to the conventional approach, with earlier rehabilitation but no malpositioning or severe complications. Wound-healing problems can be treated easily and effectively, and the risk also decreases as surgeons become more experienced, and more user-friendly instruments are invented. Potential benefits in medium- and long-term outcomes require larger, multicentre and well-conducted RCTs to confirm.

Level of evidence

Therapeutic study, Level II.

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References

  1. Ast MP, DiMaio FR (2012) Effects of a less-invasive surgical technique on cement mantle quality in total knee arthroplasty. Orthopedics 35(9):1329–1333

    Article  Google Scholar 

  2. Alcelik I, Sukeik M, Pollock R, Misra A, Shah P, Armstrong P, Dhebar MI (2012) Comparison of the minimally invasive and standard medial parapatellar approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(12):2502–2512

    Article  CAS  PubMed  Google Scholar 

  3. Boerger TO, Aglietti P, Mondanelli N, Sensi L (2005) Minisubvastus versus medial parapatellar approach in total kneearthroplasty. Clin Orthop Relat Res 440:82–87

    Article  CAS  PubMed  Google Scholar 

  4. Barrack RL, Barnes CL, Burnett RS, Miller D, Clohisy JC, Maloney WJ (2009) Minimal incision surgery as a risk factor for early failure of total knee arthroplasty. J Arthroplast 24(4):489–498

    Article  Google Scholar 

  5. Bonutti PM, Zywiel MG, Seyler TM, Lee SY, McGrath MS, Marker DR, Mont MA (2010) Minimally invasive total knee arthroplasty using the contralateral knee as a control group: a case-control study. Int Orthop 34(4):491–495

    Article  PubMed Central  PubMed  Google Scholar 

  6. Chin PL, Foo LSS, Yang KY, Yeo SJ, Lo NN (2007) Randomized controlled trial comparing the radiologic outcomes of conventional and minimally invasive techniques for total knee arthroplasty. J Arthroplast 22(6):800–806

    Article  Google Scholar 

  7. Chiang H, Lee CC, Lin WP, Jiang CC (2012) Comparison of quadriceps-sparing minimally invasive and medial parapatellar total knee arthroplasty: a 2-year follow-up study. J Formos Med Assoc 111:698–704

    Article  PubMed  Google Scholar 

  8. Cheng T, Liu T, Zhang G, Peng X, Zhang X (2010) Does minimally invasive surgery improve short-term recovery in total knee arthroplasty? Clin Orthop Relat Res 468(6):1635–1648

    Article  PubMed Central  PubMed  Google Scholar 

  9. Cheng T, Liu T, Zhang G, Zhang X (2011) Computer-navigated surgery in anterior cruciate ligament reconstruction: are radiographic outcomes better than conventional surgery? Arthroscopy 27(1):97–100

    Article  PubMed  Google Scholar 

  10. Chotanaphuti T, Ongnamthip P, Karnchanalerk K, Udombuthong P (2008) Comparative study between 2 cm limited quadriceps exposure minimally invasive surgery and conventional total knee arthroplasty in quadriceps function: prospective randomized controlled trial. J Med Assoc Thai 91(2):203–207

    PubMed  Google Scholar 

  11. Chalidis BE, Petsatodis G, Christodoulou AG, Christoforidis J, Papadopoulos PP, Pournaras J (2010) Is obesity a contraindication for minimal invasive total knee replacement? A prospective randomized control trial. Obse Surg 20(12):1633–1641

    Article  Google Scholar 

  12. Cheng T, Zhao S, Peng X, Zhang X (2012) Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 20(7):1307–1322

    Article  PubMed  Google Scholar 

  13. Dayton MR, Bade MJ, Muratore T, Shulman BC, Kohrt WM, Stevens-Lapsley JE (2012) Minimally invasive total knee arthroplasty: surgical implications for recovery. J Knee Surg 26(3):195–202

    Article  PubMed Central  PubMed  Google Scholar 

  14. Dabboussi N, Sakr M, Girard J, Fakih R (2012) Minimally invasive total knee arthroplasty: a comparative study to the standard approach. N Am J Med Sci 4(2):81–85

    Article  PubMed Central  PubMed  Google Scholar 

  15. Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC (2008) Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 90(1):2–9

    Article  PubMed  Google Scholar 

  16. Engh GA, Holt BT, Parks NL (1997) A midvastus musclesplitting approach for total knee arthroplasty. J Arthroplast 12(3):322–331

    Article  CAS  Google Scholar 

  17. Goodman S (2005) Wear particulate and osteolysis. Orthop Clin N Am 36(1):41–48

    Article  Google Scholar 

  18. Gandhi R, Dhotar H, Razak F, Tso P, Davey JR, Mahomed NN (2010) Predicting the longer term outcomes of total knee arthroplasty. Knee 17(1):15–18

    Article  PubMed  Google Scholar 

  19. Guy SP, Farndon MA, Conroy JL, Bennett C, Grainger AJ, London NJ (2012) A prospective randomized study of minimally invasive midvastus total knee arthroplasty compared with standard total knee arthroplasty. Knee 19(6):866–871

    Article  PubMed  Google Scholar 

  20. Gandhi R, Smith H, Lefaivre KA, Davey JR, Mahomed NN (2011) Complications after minimally invasive total knee arthroplasty as compared with traditional incision techniques: a meta-analysis. J Arthroplast 26(1):29–35

    Article  Google Scholar 

  21. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed Central  PubMed  Google Scholar 

  22. Hart R, Janeček M, Čižmář I, Štipčák V, Kučera B, Filan P (2006) Minimal-invasive und navigierte implantation von Knietotalendoprothesen. Radiologische analyse und frühe klinische Ergebnisse. Orthopade 35(5):552–557

    Article  CAS  PubMed  Google Scholar 

  23. Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplast 27(6):1177–1182

    Article  Google Scholar 

  24. Hernandez-Vaquero D, Noriega-Fernandez A, Suarez-Vazquez A (2010) Total knee arthroplasties performed with a mini-incision or a standard incision. Similar results at six months follow-up. BMC Musculoskelet Disord 11:27

    Article  PubMed Central  PubMed  Google Scholar 

  25. Han I, Seong SC, Lee S, Yoo JH, Lee MC (2008) Simultaneous bilateral MIS-TKA results in faster functional recovery. Clin Orthop Relat Res 466(6):1449–1459

    Article  PubMed Central  PubMed  Google Scholar 

  26. Juosponis R, Tarasevicius S, Smailys A, Kalesinskas RJ (2009) Functional and radiological outcome after total knee replacement performed with mini-midvastus or conventional arthrotomy: controlled randomised trial. Int Orthop 33(5):1233–1237

    Article  PubMed Central  PubMed  Google Scholar 

  27. Kolisek FR, Bonutti PM, Hozack WJ, Purtill J, Sharkey PF, Zelicof SB, Ragland PS, Kester M, Mont MA, Rothman RH (2007) Clinical experience using a minimally invasive surgical approach for total knee arthroplasty. Early results of a prospective randomized study compared to a standard approach. J Arthroplast 22(1):8–13

    Article  Google Scholar 

  28. Khanna A, Gougoulias N, Longo UG, Maffulli N (2009) Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin N Am 40(4):479–489

    Article  Google Scholar 

  29. Karachalios T, Giotikas D, Roidis N, Poultsides L, Bargiotas K, Malizos KN (2008) Total knee replacement performed with either a mini-midvastus or a standard approach: a prospective randomised clinical and radiological trial. J Bone Joint Surg Br 90(5):584–591

    Article  PubMed  Google Scholar 

  30. Kim YH, Kim JS, Kim DY (2007) Clinical outcome and rate of complications after primary total knee replacement performed with quadriceps-sparing or standard arthrotomy. J Bone Joint Surg Br 89(4):467–470

    Article  PubMed  Google Scholar 

  31. Kim JG, Lee SW, Ha JK, Choi HJ, Yang SJ, Lee MY (2011) The effectiveness of minimally invasive total knee arthroplasty to preserve quadriceps strength: a randomized controlled trial. Knee 18(6):443–447

    Article  PubMed  Google Scholar 

  32. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785

    Article  PubMed  Google Scholar 

  33. Karpman RR, Smith HL (2009) Comparison of the early results of minimally invasive vs. standard approaches to total knee arthroplasty. J Arthroplast 24(5):681–688

    Article  Google Scholar 

  34. Kashyap SN, van Ommeren JW (2008) Clinical experience with less invasive surgery techniques in total knee arthroplasty: a comparative study. Knee Surg Sports Traumatol Arthrosc 16(6):544–548

    Article  PubMed  Google Scholar 

  35. Kashyap SN, van Ommeren JW, Shankar S (2009) Minimally invasive surgical technique in total knee arthroplasty: a learning curve. Surg Innov 16(1):55–62

    Article  PubMed  Google Scholar 

  36. Lüring C, Beckmann J, Haiböck P, Perlick L, Grifka J, Tingart M (2008) Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial. Knee Surg Sports Traumatol Arthrosc 16(10):928–934

    Article  PubMed  Google Scholar 

  37. Lee DH, Choi J, Nha KW, Kim HJ, Han SB (2011) No difference in early functional outcomes for mini-midvastus and limited medial parapatellar approaches in navigation-assisted total knee arthroplasty: a prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 19(1):66–73

    Article  CAS  PubMed  Google Scholar 

  38. Lin WP, Lin J, Horng LC, Chang SM, Jiang CC (2009) Quadriceps-sparing, minimal-incision total knee arthroplasty. A comparative study. J Arthroplast 24(7):1024–1032

    Article  Google Scholar 

  39. Lachiewicz PF, Soileau ES (2009) Fifteen year survival and osteolysis associated with a modular posterior stabilized knee replacement: a concise follow-up of a previous report. J Bone Joint Surg Am 91(6):1419–1423

    Article  PubMed  Google Scholar 

  40. Liu Z, Yang H (2011) Comparison of the minimally invasive and standard midial parapatellar approach for total knee arthroplasty: systematic review and meta-analysis. J Int Med Res 39(5):1607–1617

    Article  CAS  PubMed  Google Scholar 

  41. Maru M, Akra G, McMurtry I, Port A (2009) A prospective comparative study of the midvastus and medial parapatellar approaches for total knee arthroplasty in the early postoperative period. Eur J Orthop Surg Traumatol 19(7):473–476

    Article  Google Scholar 

  42. Matsumoto T, Muratsu H, Kubo S, Mizuno K, Kinoshita K, Ishida K, Matsushita T, Sasaki K, Tei K, Takayama K, Sasaki H, Oka S, Kurosaka M, Kuroda R (2011) Soft tissue balance measurement in minimal incision surgery compared to conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19(6):880–886

    Article  PubMed  Google Scholar 

  43. Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y (2011) Clinical and radiographic outcomes of minimally invasive total knee arthroplasty through a lateral approach. Knee Surg Sports Traumatol Arthrosc 19(6):973–979

    Article  PubMed  Google Scholar 

  44. Niki Y, Mochizuki T, Momohara S, Saito S, Toyama Y, Matsumoto H (2009) Is minimally invasive surgery in total knee arthroplasty really minimally invasive surgery? J Arthroplast 24(4):499–504

    Article  Google Scholar 

  45. Nestor BJ, Toulson CE, Backus SI, Lyman SL, Foote KL, Windsor RE (2010) Mini-midvastus versus standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty. J Arthroplast 25(Suppl 6):5–11

    Article  Google Scholar 

  46. Pivec R, Issa K, Kester M, Harwin SF, Mont MA (2013) Long-term outcomes of MUA for stiffness in primary TKA. J Knee Surg 26(6):405–410

    Google Scholar 

  47. Pan WM, Li XG, Tang TS, Qian ZL, Zhang Q, Zhang CM (2010) Mini-subvastus versus a standard approach in total knee arthroplasty: a prospective, randomized, controlled study. J Int Med Res 38(3):890–900

    Article  PubMed  Google Scholar 

  48. Pescador D, Moreno AA, Blanco JF, Garcia I (2011) Long-term analysis of minimally invasive surgery in knee arthroplasty. Acta Ortop Mex 25(6):353–358

    CAS  PubMed  Google Scholar 

  49. Parentis MA, Rumi MN, Deol GS, Kothari M, Parrish WM, Pellegrini VD (1999) A comparison of the vastus splitting and median parapatellar approaches in total knee arthroplasty. Clin Orthop Relat Res 367:107–116

    Article  PubMed  Google Scholar 

  50. Pei-liang F, Xiao-hua L, Yu-li W (2008) Comparison of midvastus and standard medial parapatellar approaches in total knee arthroplasty. Zhongguo Zuzhi Gongcheng Yanjiu Yu Linchuang Kangfu 12(9):1793–1796

    Google Scholar 

  51. Rousseau MA, Lazennec JY, Catonne Y (2008) Early mechanical failure in total knee arthroplasty. Int Orthop 32(1):53–56

    Article  PubMed Central  PubMed  Google Scholar 

  52. Stevens-Lapsley JE, Bade MJ, Shulman BC, Kohrt WM, Dayton MR (2012) Minimally invasive total knee arthroplasty improves early knee strength but not functional performance-A randomized controlled trial. J Arthroplast 27(10):1812–1820

    Article  Google Scholar 

  53. Smith TO, King JJ, Hing CB (2012) A meta-analysis of randomized controlled trials comparing the clinical and radiological outcomes following minimally invasive to conventional exposure for total knee arthroplasty. Knee 19(1):1–7

    Article  PubMed  Google Scholar 

  54. Seon JK, Song EK (2006) Navigation-assisted less invasive total knee arthroplasty compared with conventional total knee arthroplasty. A randomized prospective trial. J Arthroplast 21(16):777–782

    Article  Google Scholar 

  55. Thienpont E (2012) Faster recovery after minimally invasive surgery in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(10):2370–2374

    Article  PubMed  Google Scholar 

  56. Tasker A, Hassaballa M, Murray J, Lancaster S, Artz N, Harries W, Porteous A (2013) Minimally invasive total knee arthroplasty; a pragmatic randomised controlled trial reporting outcomes up to 2 year follow up. Knee 21:189–193

    Google Scholar 

  57. Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamoto Y (2007) Minimally invasive versus standard approach in total knee arthroplasty. Clin Orthop Relat Res 463:144–150

    PubMed  Google Scholar 

  58. Varnell MS, Bhowmik-Stoker M, McCamley J, Jacofsky MC, Campbell M, Jacofsky D (2011) Difference in stair negotiation ability based on TKA surgical approach. J Knee Surg 24(2):117–123

    Article  PubMed  Google Scholar 

  59. Varela-Egocheaga JR, Suarez-Suarez MA, Fernandez-Villan M, Gonzalez-Sastre V, Varela-Gomez JR, Rodriguez-Merchan C (2010) Minimally invasive subvastus approach: improving the results of total knee arthroplasty: a prospective, randomized trial. Clin Orthop Relat Res 468(5):1200–1208

    Article  PubMed Central  PubMed  Google Scholar 

  60. White RE Jr, Allman JK, Trauger JA, Dales BH (1999) Clinical comparison of the midvastus and medial parapatellar surgical approaches. Clin Orthop Relat Res 367:117–122

    Article  PubMed  Google Scholar 

  61. Wülker N, Lambermont JP, Sacchetti L, Lazaro JG (2010) A prospective randomized study of minimally invasive total knee arthroplasty compared with conventional surgery. J Bone Joint Surg Am 92(7):1584–1590

    Article  PubMed  Google Scholar 

  62. Wegrzyn J, Parratte S, Coleman-Wood K, Kaufman KR, Pagnano MW (2013) No benefit of minimally invasive TKA on gait and strength outcomes a randomized controlled trial. Clin Orthop Relat Res 471(1):46–55

    Article  PubMed Central  PubMed  Google Scholar 

  63. Yang JH, Yoon JR, Pandher DS, Oh KJ (2010) Clinical and radiologic outcomes of contemporary 3 techniques of TKA. Orthopedics 33(10 Suppl):76–81

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This research was funded by the China Health Ministry Program (201302007). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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  1. Orthopedic Department, West China Hospital, Sichuan University, Chengdu, China

    Canfeng Li, Yi Zeng, Bin Shen, Pengde Kang, Jing Yang, Zongke Zhou & Fuxing Pei

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  1. Canfeng Li
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Correspondence to Bin Shen.

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Li, C., Zeng, Y., Shen, B. et al. A meta-analysis of minimally invasive and conventional medial parapatella approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23, 1971–1985 (2015). https://doi.org/10.1007/s00167-014-2837-4

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