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Wang YC, Wu SH, Chen CA, Liang JM, Yang CC, Chen CH, Chung WR, Chou PPH, Huang HT. Compare the Quadriceps Activity between Mini-Midvastus and Mini-Medial Parapatellar Approach in Total Knee Arthroplasty with Electromyography. J Clin Med 2024; 13:2736. [PMID: 38792280 PMCID: PMC11122619 DOI: 10.3390/jcm13102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/18/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The comparison between the mini-midvastus (mini-MV) and mini-parapatellar (mini-MPP) approach in total knee arthroplasty (TKA) remains a subject of debate. The present study compared quadriceps activation, pain levels, and clinical outcomes between the two approaches; quadricep activation was assessed using surface electromyography (sEMG). Methods: This retrospective cross-sectional study comprised a total of 78 patients aged between 50 and 85 years with primary osteoarthritis. Patients were divided into a mini-MV (n = 38) group and a mini-MPP (n = 40) group according to the surgical approach. Results: The two groups exhibited no significant differences in sEMG for the vastus medialis (VM) or rectus femoris (RF) at the follow-up time points, with the exception that the mini-MV group exhibited superior strength of RF during extensions at the 2-week follow-up. However, the mini-MPP group had superior Western Ontario and McMaster Universities Index (WOMAC) total and function scores at the 2- and 6-week follow-ups. The mini-MPP group also had superior WOMAC stiffness scores at the 2-week follow-up. The two groups did not differ significantly in terms of pain levels or morphine consumption. Conclusions: The sEMG data of quadriceps muscle would not differ significantly between the mini-MV and mini-MPP approaches for TKA. Moreover, the mini-MPP approach may yield superior WOMAC scores when compared with the mini-MV approach.
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Affiliation(s)
- Ying-Chun Wang
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Sheng-Hua Wu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.W.); (C.-A.C.)
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chi-An Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.W.); (C.-A.C.)
| | - Jing-Min Liang
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Chia-Chi Yang
- The Master Program of Long-Term Care in Aging, College of Nursing, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wan-Rong Chung
- Department of Anesthesiology, E-Da Hospital, Kaohsiung 807, Taiwan;
- College of Medicine, I-Shou University, Kaohsiung 807, Taiwan
| | - Paul Pei-Hsi Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsuan-Ti Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Yuan F, Sun Z, Fu J, Yang M, Zhang J, Chen Y, Yu J. Do minimally invasive approaches affect long-term clinical outcomes of total knee arthroplasty? A cohort analysis with a minimum 10-year follow-up. Chin Med J (Engl) 2023; 136:1376-1378. [PMID: 37130225 PMCID: PMC10309502 DOI: 10.1097/cm9.0000000000002125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Indexed: 05/04/2023] Open
Affiliation(s)
- Fuzhen Yuan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Zewen Sun
- Qingdao Medical College, Qingdao University, Qingdao, Shandong 266000, China
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
| | - Jiangnan Fu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Meng Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Jiying Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Yourong Chen
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
| | - Jiakuo Yu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100191, China
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Khan MNH, Abbas K, Faraz A, Ilyas MW, Shafique H, Jamshed MH, Hashmi P. Total knee replacement: A comparison of the subvastus and medial parapatellar approaches. Ann Med Surg (Lond) 2021; 68:102670. [PMID: 34408867 PMCID: PMC8361225 DOI: 10.1016/j.amsu.2021.102670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 10/27/2022] Open
Abstract
Objective The goal of this study is to compare the subvastus method to the usual medial parapatellar technique for total knee replacement in patients with osteoarthritis who present to a tertiary care centre, based on quadriceps function recovery in days after surgery. Materials and methods We retrospectively reviewed case notes of 76 patients with osteoarthritis who had total knee replacements in a tertiary care hospital over the course of a year from August 2019 to August 2020. We divided them into two groups: group A received TKR via the subvastus approach, and group B received TKR via the medial parapatellar approach. Preoperative quadriceps strength, BMI, and baseline demographics were all recorded from their initial pre-operative workup case notes. Starting on the first postoperative day, patients recorded first unassisted straight leg raise (SLR) was kept as the main determinant for muscle function. The data were evaluated to determine the quadriceps muscle function post TKR. Results When compared to the medial parapatellar approach, the quadriceps muscle function returns sooner with the subvastus technique. Patients in their sixties showed the highest improvement. Preoperative quadriceps strength has a major impact on muscle recovery after surgery. Conclusion The subvastus method to total knee replacement is linked to a faster recovery of quadriceps muscle strength, resulting in a shorter hospital stay and postoperative therapy.
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Affiliation(s)
| | - Kashif Abbas
- Trauma and Orthopaedics University Hospital Southampton, NHS Foundation Trust, UK
| | - Ahmad Faraz
- Royal Victoria Hospital, Belfast 274 Grovsner Road, BT12 6BA, UK
| | - Muhammad Waqas Ilyas
- Trauma and Orthopaedics, University Hospital Southampton, NHS Foundation Trust, UK
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Morelli I, Maffulli N, Brambilla L, Agnoletto M, Peretti GM, Mangiavini L. Quadriceps muscle group function and after total knee arthroplasty-asystematic narrative update. Br Med Bull 2021; 137:51-69. [PMID: 33517365 DOI: 10.1093/bmb/ldaa041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND This article systematically summarizes the present evidences, published in the last 20 years, regarding the pre- and post-operative factors, which may influence recovery of the function of the quadriceps muscle group following total knee arthroplasty (TKA). We following the PRISMA methodology, including meta-analyses and high-level evidence studies (prospective trials, and, when unavailable, retrospective studies). SOURCES OF DATA Pubmed and Cochrane databases: 582 articles were identified and 54 of them were selected. AREAS OF AGREEMENT Tourniquets inflated at high pressure exert a detrimental effect on the quadriceps muscle group. Faster quadriceps recovery takes place using mini-invasive approaches, an eight-week rehabilitation period including balance training and the use of nutraceuticals. AREAS OF DISAGREEMENT Pre-habilitation and pre-operative factors, analgesic methods and different TKA implants. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH Telerehabilitation seems a cost-effective tool for rehabilitation after TKA. Patients' optimization protocols before TKA should include standardized nutraceuticals intake.
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Affiliation(s)
- Ilaria Morelli
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Nicola Maffulli
- San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Via San Leonardo, 84125 Salerno, Italy.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, Staffordshire ST5 5BG United Kingdom.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, United Kingdom
| | - Lorenzo Brambilla
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Marco Agnoletto
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Giuseppe Maria Peretti
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, via Luigi Mangiagalli 31, 20133 Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, via Luigi Mangiagalli 31, 20133 Italy
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Migliorini F, Eschweiler J, Baroncini A, Tingart M, Maffulli N. Better outcomes after minimally invasive surgeries compared to the standard invasive medial parapatellar approach for total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3608-3620. [PMID: 33021687 PMCID: PMC8514366 DOI: 10.1007/s00167-020-06306-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Minimally invasive surgery (MIS) for total knee arthroplasty (TKA) is often marketed as being able to speed up healing times over standard invasive surgery (SIS) through the medial parapatellar approach. The advantages of these minimally invasive approaches, however, are not yet definitively established. A meta-analysis of studies comparing peri-operative and post-operative differences and long-term complications of MIS versus SIS for TKA was conducted. METHODS This meta-analysis was conducted following the PRISMA guidelines. The Pubmed, Google Scholar, Scopus, and Embase databases were accessed in September 2020. All clinical trials comparing minimally-invasive versus standard approaches for TKA were considered. Only studies reporting quantitative data under the outcomes of interest were included. Methodological quality assessment was performed using the PEDro appraisal score. RESULTS This meta-analysis covers a total of 38 studies (3296 procedures), with a mean 21.3 ± 24.3 months of follow-up. The MIS group had shorter hospitalization times, lower values of total estimated blood loss, quicker times of straight-leg raise, greater values for range of motion, higher scores on the Knee Society Clinical Rating System (KSS) and its related Function Subscale (KSFS). Pain scores, anterior knee pain and revision rate were similar between MIS and SIS. SIS allowed a quicker surgical duration. CONCLUSION The present meta-analysis encourages the use of minimally invasive techniques for total knee arthroplasty. However, MIS TKA is technically demanding and requires a long learning curve. LEVEL OF EVIDENCE III, meta-analysis of clinical trials.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA Italy ,Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG England ,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England
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6
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Lin W, Niu J, Dai Y, Yang G, Li M, Wang F. Mini-midvastus versus medial parapatellar approach in total knee arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score. J Orthop Surg Res 2020; 15:336. [PMID: 32807190 PMCID: PMC7433095 DOI: 10.1186/s13018-020-01869-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background Low knee awareness after minimally invasive total knee arthroplasty (TKA) has become the ultimate target of a natural-feeling knee that meets patient expectations. The objective of this research was to compare the clinical outcomes of TKA via the mini-midvastus (MMV) approach or the medial parapatellar (MPP) approach, and to evaluate which approach can lead to a better quality of life after surgery. Methods From January 2015 to December 2016, a retrospective cohort study was conducted in 330 patients who underwent TKA via a mini-midvastus (MMV) approach. During this period, we also selected 330 patients who underwent TKA via a medial parapatellar (MPP) approach (MPP group) for comparison. Clinical results were assessed with the visual analog scale score for pain, range of motion, and the Knee Society Score. The Forgotten Joint Score was used to analyze the ability to forget the joint. Results There were significant differences with regard to visual analog scale score, range of motion, and the Knee Society Score until 6 months after surgery between the MMV and MPP groups (p < 0.05), but the differences were not significant at 12 months, 24 months, and 36 months after surgery. However, there were significant differences in the Forgotten Joint Score between the groups during the follow-up period (p < 0.05). Conclusion When forgetting the artificial joint after TKA is the ultimate target, better quality of life can be acquired by performing TKA via the MMV approach. In addition, compared with the MPP approach, the MMV approach can offer less pain and a faster recovery.
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Affiliation(s)
- Wei Lin
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Jinghui Niu
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yike Dai
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Guangmin Yang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Ming Li
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Fei Wang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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7
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Migliorini F, Aretini P, Driessen A, El Mansy Y, Quack V, Tingart M, Eschweiler J. Better outcomes after mini-subvastus approach for primary total knee arthroplasty: a Bayesian network meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:979-992. [PMID: 32152747 PMCID: PMC8203553 DOI: 10.1007/s00590-020-02648-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/03/2020] [Indexed: 12/25/2022]
Abstract
Introduction Alternatives to the classical medial parapatellar (MPP) approach for total knee arthroplasty (TKA) include the mini-medial parapatellar (MMPP), mini-subvastus (MSV), mini-midvastus (MMV) and quadriceps-sparing (QS) approaches. The best approach has been not fully clarified. The purpose of the present study was to conduct a Bayesian network meta-analysis comparing these approaches. Materials and methods The present analysis was carried out according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. The databases search was performed in October 2019. All clinical trials comparing two or more approaches for primary TKA were considered for inclusion. The baseline comparability was evaluated through the analysis of variance (ANOVA) test. The statistical analysis was performed through the STATA software/MP. A Bayesian hierarchical random-effects model analysis was adopted in all the comparisons. Results Data from 52 articles (4533 patients) were collected. The mean follow-up was 20.38 months. With regard to diagnosis, gender, age and BMI, adequate baseline comparability was detected. The MSV approach ranked better concerning clinical scores (the lowest visual analogic scale, the higher KSS and KSFS) and functional outcomes (the shortest straight leg raise, the greatest degree of flexion and range of motion). Concerning perioperative data, the MSV evidenced the shortest hospital stay, while the MPP the shortest surgical duration and lowest estimated blood loss. Conclusion According to the main findings of the present study, the mini-subvastus approach for total knee arthroplasty demonstrated superior overall compared to the other approaches. Orthopaedic surgeons should consider this approach in the light of the evidence and limitations of this Bayesian network meta-analysis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Paolo Aretini
- Fondazione Pisana per la Scienza, Via Ferruccio Giovannini 13, 56017, Pisa, Italy
| | - Arne Driessen
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Yasser El Mansy
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Orthopaedic and Traumatology, Alexandria University, Alexandria, Egypt
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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8
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Onggo JR, Onggo JD, Hau R. Comparable outcomes in mini-midvastus versus mini-medial parapatellar approach in total knee arthroplasty: a meta-analysis and systematic review. ANZ J Surg 2020; 90:840-845. [PMID: 32062865 DOI: 10.1111/ans.15719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) techniques in total knee arthroplasties (TKA) have gained popularity over conventional techniques due to benefits of hastened recovery and reduced complications. There are a variety of MIS techniques available and two most common techniques currently employed are the mini-midvastus (mMV) and mini-medial parapatellar (mMPP) approaches. This meta-analysis aims to compare the clinical outcomes and peri-operative parameters between mMV and mMPP in TKA in order to determine the presence of a superior technique. METHODS A multi-database search was performed according to PRISMA guidelines. Data from studies comparing clinical outcomes and peri-operative parameters between mMV and mMPP approaches in TKA were extracted and analysed. RESULTS A total of five randomized controlled trials were included for analysis, consisting of 190 mMV and 189 mMPP knees. Clinically unimportant differences were noted in blood loss and surgical time between the groups (5 mL less blood loss and 7 min less surgical time in mMV, P < 0.001). There was no statistically significant difference between both groups for Knee Society Score at 1 and 2 years, range of motion at 1 and 2 years, incision length or incidence of lateral retinacular release (all non-significant, P > 0.05). CONCLUSION The mMV and mMPP MIS TKA approaches have equivalent clinical outcomes. Despite a statistically significant longer operative time and higher mean blood loss in mMV than mMPP approach, clinically significant difference was not demonstrated. Both mMV and mMPP MIS techniques are reliable and safe to perform in TKA.
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Affiliation(s)
- James R Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Flinders Medical School, Flinders University, Adelaide, South Australia, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Northern Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Epworth Eastern Hospital, Melbourne, Victoria, Australia
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9
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Picard F, Deakin A, Balasubramanian N, Gregori A. Minimally invasive total knee replacement: techniques and results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2018; 28:781-791. [PMID: 29564615 PMCID: PMC6003981 DOI: 10.1007/s00590-018-2164-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/18/2018] [Indexed: 02/07/2023]
Abstract
In this review, we outlined the definition of minimally invasive surgery (MIS) in total knee replacement (TKR) and described the different surgical approaches reported in the literature. Afterwards, we went through the most recent studies assessing MIS TKR. Next, we searched for potential limitations of MIS knee replacement and tried to answer the following questions: Are there selective criteria and specific patient selection for MIS knee surgery? If there are, then what are they? After all, a discussion and conclusion completed this article. There is certainly room for MIS or at least less invasive surgery for appropriate selected patients. Nonetheless, there are differences between approaches. Mini-medial parapatellar is easy to master, quick to perform and potentially extendable, whereas mini-subvastus and mini-midvastus are trickier and require more caution related to risk of haematoma and vastus medialis oblique (VMO) nerve damage. Current evidence on the safety and efficacy of mini-incision surgery for TKR does not appear fully adequate for the procedure to be used without special arrangements for consent and for audit or continuing research. There is an argument that a sudden jump from standard TKR to MIS TKR, especially without computer assistance such as navigation, patient-specific instrumentation or robotic, may breach a surgeon's duty of care towards patients because it exposes patients to unnecessary risks. As a final point, more evidence is required on the long-term safety and efficacy of this procedure which will give objective shed light on real benefits of MIS TKR.
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Affiliation(s)
- Frederic Picard
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.
- Biomedical Engineering, Strathclyde University, Glasgow, UK.
| | - Angela Deakin
- Biomedical Engineering, Strathclyde University, Glasgow, UK
- Surgiconcept Ltd, Glasgow, UK
| | | | - Alberto Gregori
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
- Hairmyres Hospital, Eaglesham East Kilbride, Glasgow, G758RG, UK
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10
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Tzatzairis T, Fiska A, Ververidis A, Tilkeridis K, Kazakos K, Drosos GI. Minimally invasive versus conventional approaches in total knee replacement/arthroplasty: A review of the literature. J Orthop 2018; 15:459-466. [PMID: 29881177 DOI: 10.1016/j.jor.2018.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/25/2018] [Indexed: 02/06/2023] Open
Abstract
Background Life expectancy lengthening and aging of population resulted in dramatically increase of patients with osteoarthritis. Total knee arthroplasty is widely used as the gold standard in order to relieve pain, correct deformity and restore function. A contemporary and controversial topic, is that of minimally invasive surgery for TKA. The minimally invasive approaches are based on the concept that they don't violate the extensor mechanism, resulting in earlier functional recovery, shorter hospital stay and enhanced patients' overall satisfaction. The most commonly used MIS approaches in TKA are the subvastus, midvastus and the quadriceps sparing. There is a debate regarding the efficacy and safety of these methods. Objective In this article we will review the current literature (randomized controlled trials and systematic reviews/meta-analyses) on MIS compared to traditional approach and analyse their clinical safety, efficacy and long-term results. Design Comparison of well-designed studies have tried to demonstrate the advantages/disadvantages, the clinical results and the complications of the MIS approaches compared to the MPP approach. Results MIS approaches seem to provide advantages in the immediate post-operative period accompanied by increased reports of complications. Consequently, further investigation based on large well-designed studies with long-term results are warranted to further clarify MIS effectiveness/safety.
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Affiliation(s)
- Themistoklis Tzatzairis
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece
| | - Aliki Fiska
- Department of Anatomy, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece
| | - Athanasios Ververidis
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece
| | - Konstantinos Tilkeridis
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece
| | - Konstantinos Kazakos
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece
| | - Georgios I Drosos
- Department of Orthopaedic Surgery, Medical School, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100 Alexandroupolis, Greece
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Verburg H, Mathijssen NMC, Niesten DD, Verhaar JAN, Pilot P. Comparison of Mini-Midvastus and Conventional Total Knee Arthroplasty with Clinical and Radiographic Evaluation: A Prospective Randomized Clinical Trial with 5-Year Follow-up. J Bone Joint Surg Am 2016; 98:1014-22. [PMID: 27307362 DOI: 10.2106/jbjs.15.00654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The main objective of this prospective randomized study was to compare the clinical and radiographic outcomes of the mini-midvastus (MMV) approach with the conventional approach for total knee arthroplasty at the 5-year follow-up. METHODS Ninety-seven patients (100 knees) with osteoarthritis were assigned to the MMV group or to a group receiving conventional total knee arthroplasty. Intraoperative and postoperative clinical data were collected. At 6 weeks and at 1, 2, and 5 years postoperatively, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), the Knee Society Score (KSS), and the Short Form (SF)-12 were completed. Radiographs of the knee were made preoperatively and at 1 day and 1 and 5 years postoperatively. Computed tomography (CT) scans were performed 2 years postoperatively. RESULTS In the MMV group, the mean skin incision was 2.5 cm shorter (p < 0.001) and the mean duration of the operation was 6 minutes longer than in the conventional total knee arthroplasty group (p < 0.05). Eight patients in the conventional group had a lateral parapatellar retinacular release compared with 1 in the MMV group; the difference was significant (p = 0.01). Three intraoperative complications, including 2 small lateral femoral condylar fractures and 1 partial patellar tendon laceration, occurred in the MMV group. Seven patients in the MMV group had postoperative blisters; all of them had a relatively large femoral component and 4 of them were large men. The radiographs and CT scans of the prostheses showed no significant differences between the MMV and conventional groups except for the posterior slope of the tibial component. In addition, no significance differences were detected between the groups with respect to the KOOS, OKS, KSS, and SF-12 scores determined at the 6-week and the 1, 2, and 5-year follow-up evaluations. CONCLUSIONS In the rehabilitation period and at the short and mid-term follow-up, no relevant clinical and radiographic differences were found between the MMV and the conventional approach for total knee arthroplasty, making the advantage of MMV total knee arthroplasty cosmetic. We discourage the use of the MMV approach in large male patients because of the increased number of intraoperative complications and skin blisters postoperatively. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hennie Verburg
- Departments of Orthopaedic Surgery (H.V. and D.-D.N.) and Orthopaedic Research (N.M.C.M. and P.P.), Reinier de Graaf Groep, Delft, the Netherlands
| | - Nina M C Mathijssen
- Departments of Orthopaedic Surgery (H.V. and D.-D.N.) and Orthopaedic Research (N.M.C.M. and P.P.), Reinier de Graaf Groep, Delft, the Netherlands
| | - Dieu-Donné Niesten
- Departments of Orthopaedic Surgery (H.V. and D.-D.N.) and Orthopaedic Research (N.M.C.M. and P.P.), Reinier de Graaf Groep, Delft, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter Pilot
- Departments of Orthopaedic Surgery (H.V. and D.-D.N.) and Orthopaedic Research (N.M.C.M. and P.P.), Reinier de Graaf Groep, Delft, the Netherlands
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Ang CL, Yeo SJ. Quality of cementation in conventional versus minimally invasive total knee arthroplasty. J Orthop Surg (Hong Kong) 2016; 24:7-11. [PMID: 27122504 DOI: 10.1177/230949901602400104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To review the immediate postoperative radiographs of 108 patients following conventional or minimally invasive total knee arthroplasty (TKA) to assess the quality of cementation in terms of cement voids and retained cement. METHODS Records of 20 male and 88 female consecutive patients aged 50 to 83 (mean, 67.5) years who underwent conventional TKA (n=56) or computer-assisted minimally invasive TKA (n=52) for osteoarthritis by a single senior surgeon were reviewed. Immediate postoperative radiographs were assessed by a single blinded assessor for the quality of cementation in terms of cement void and retained cement in different zones of the femoral, tibial, and patellar components along the prosthesis-bone interface using the Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. RESULTS The 2 groups were comparable in terms of baseline demographics as well as cement void and retained cement on the femoral, tibial, and patellar components, except that in the minimally invasive group, cement void beneath the anterior flange of the femoral component was wider (0.32 vs. 0 mm, p=0.001), and retained cement in the posterior or lateral aspects of the tibial component was more common (50.0% vs. 28.6%, p=0.018). CONCLUSION Minimally invasive TKA resulted in a wider cement void beneath the anterior flange of the femoral component and a higher rate of retained cement around the tibial component.
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Affiliation(s)
- C L Ang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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13
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Feczko P, Engelmann L, Arts JJ, Campbell D. Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique: A prospective, randomized, international multicentre trial. BMC Musculoskelet Disord 2016; 17:19. [PMID: 26762175 PMCID: PMC4711101 DOI: 10.1186/s12891-016-0872-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/05/2016] [Indexed: 12/18/2022] Open
Abstract
Background Despite 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). Methods A 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. Results Patients 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. Conclusion There 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 number ClinicalTrials.gov NCT02625311 8 December 2015
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Affiliation(s)
- Peter Feczko
- Department Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Lutz Engelmann
- Heinrich-Braun-Krankenhaus Zwickau, Städtisches Klinikum, Zwickau, Germany
| | - Jacobus J Arts
- Department Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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14
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Tria AJ, Scuderi GR. Minimally invasive knee arthroplasty: An overview. World J Orthop 2015; 6:804-11. [PMID: 26601062 PMCID: PMC4644868 DOI: 10.5312/wjo.v6.i10.804] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/03/2015] [Accepted: 08/30/2015] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery (MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty (UKA). Partial knee replacements were designed in the 1970s and were amenable to a more limited exposure. In the 1990s Repicci popularized the MIS for UKA. Surgeons began to apply his concepts to total knee arthroplasty. Four MIS surgical techniques were developed: quadriceps sparing, mini-mid vastus, mini-subvastus, and mini-medial parapatellar. The quadriceps sparing technique is the most limited one and is also the most difficult. However, it is the least invasive and allows rapid recovery. The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended. The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient. The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques. The surgeries are easier with smaller instruments but can be performed with standard ones. The techniques are accurate and do lead to a more rapid recovery, with less pain, less blood loss, and greater motion if they are appropriately performed.
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15
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Peng X, Zhang X, Cheng T, Cheng M, Wang J. Comparison of the quadriceps-sparing and subvastus approaches versus the standard parapatellar approach in total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2015; 16:327. [PMID: 26520065 PMCID: PMC4628282 DOI: 10.1186/s12891-015-0783-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/02/2015] [Indexed: 11/13/2022] Open
Abstract
Background The quadriceps-sparing and subvastus approaches are two of the most commonly used minimally-invasive approaches in total knee arthroplasty (TKA). However, the conclusion among studies still remains controversial. The purpose of this meta-analysis was to compare the clinical efficacy of the subvastus and quadriceps-sparing approaches with the standard parapatellar approach in TKA. Methods Randomized controlled trials (RCTs) comparing the quadriceps-sparing or subvastus approach with the standard parapatellar approach was identified in the databases of PubMed, the Cochrane library, EMBASE and Web of Science up to July 2014. Two authors extracted the following data: the basic characteristics of patients, the methodological quality and clinical outcomes from the included RCTs independently. RevMan 5.2.7 software was used for meta-analysis. Results A total of 19 RCTs (1578 patients) were included for meta-analysis. The results suggested that the quadriceps-sparing approach showed better outcomes in knee society score (KSS) and visual analog score (VAS), but this approach required a longer operative time than the standard parapatellar approach. There were no differences in total complications, wound infection, deep vein thrombosis, blood loss and hospital stay between the quadriceps-sparing and standard approaches. The subvastus approach showed better outcomes in VAS, knee range of motion (ROM), straight leg raise and lateral retinacular release than the standard parapatellar approach. There were no differences in KSS, total complication, wound infection, deep vein thrombosis, blood loss and hospital stay between the quadriceps-sparing and standard approaches. Conclusions The current evidence showed that, when compared with the standard parapatellar approach, the quadriceps-sparing approach was associated with better outcomes in KSS and VAS but required a longer operative time, and the subvastus approach was associated with better outcomes in VAS, ROM, straight leg raise and lateral retinacular release.
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Affiliation(s)
- Xiaochun Peng
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
| | - Xianlong Zhang
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
| | - Tao Cheng
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
| | - Mengqi Cheng
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
| | - Jiaxing Wang
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
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16
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Huang AB, Wang HJ, Yu JK, Yang B, Ma D, Zhang JY. Are There Any Clinical and Radiographic Differences Between Quadriceps-sparing and Mini-medial Parapatellar Approaches in Total Knee Arthroplasty After a Minimum 5 Years of Follow-up? Chin Med J (Engl) 2015; 128:1898-904. [PMID: 26168830 PMCID: PMC4717936 DOI: 10.4103/0366-6999.160521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although the early clinical outcomes of total knee arthroplasty (TKA) using minimally invasive surgery techniques have been widely described, data on the mid- to long-term outcomes are limited. We designed a retrospective study to compare the two most common TKA techniques - The modified quadriceps-sparing (m-QS) approach and the mini-medial parapatellar (MMP) approach - In terms of the clinical and radiographic parameters, over a minimum follow-up period of 5 years. METHODS The m-QS approach was used in 31 knees and the MMP approach, in 36 knees. Knees in both groups were compared for component position and alignment, knee alignment, length of the skin incision, range of motion, Visual Analog Scale score, muscle torques, Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and number of complications. RESULTS There were no major intergroup differences in any of the clinical and radiographic outcomes assessed at the final follow-up examination. CONCLUSIONS On the basis of numbers studied, the m-QS group, which requires more technique, showed equivalent results with the MMP group in the postoperative 5 years. Preservation of the extensor mechanism in the m-QS approach could not ensure any improvement in the clinical outcomes during the mid-term follow-up duration.
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Affiliation(s)
- Ai-Bing Huang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hai-Jun Wang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Jia-Kuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
- Address for correspondence: Dr. Jia-Kuo Yu, Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China E-Mail:
| | - Bo Yang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Dong Ma
- Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Ji-Ying Zhang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
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Huang AB, Wang HJ, Yu JK, Yang B, Ma D, Zhang JY. Optimal patellar alignment with minimally invasive approaches in total knee arthroplasty after a minimum five year follow-up. INTERNATIONAL ORTHOPAEDICS 2015; 40:487-92. [PMID: 26162985 DOI: 10.1007/s00264-015-2896-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/20/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Patellofemoral syndrome is still a common complication after total knee arthroplasty (TKA). However, the effects of specific surgical approaches on patellar tracking and alignment remain incompletely understood. In this study, we compared patellar alignment in patients who underwent TKA via three different techniques. METHODS A total of 96 patients who completed a minimum follow-up of five years were involved in three groups: 30 patients were treated with the traditional medial parapatellar approach (MPP group), 35 patients were treated with the mini-medial parapatellar approach (MMP group) and 31 were treated with a quadriceps-sparing approach (QS group). Radiographic data for patellar alignment and clinical results were compared. RESULTS Patellar tilt and patellar displacement at the final follow-up evaluation differed significantly among the three groups [P < 0.01, analysis of variance (ANOVA)]. The MMP and QS groups exhibited more proper patellar alignment than the MPP group. The clinical results did not differ significantly among the groups (P > 0.05, ANOVA). In addition, there were no correlations between postoperative patellar alignment and clinical scores. CONCLUSIONS The results of this study indicate that TKA performed using minimally invasive approaches yields superior patellar alignment compared to the traditional MPP approach.
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Affiliation(s)
- Ai-Bing Huang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Hai-Jun Wang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Jia-Kuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China.
| | - Bo Yang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Dong Ma
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Ji-Ying Zhang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
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18
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Total knee arthroplasty performed with either a mini-subvastus or a standard approach: a prospective randomized controlled study with a minimum follow-up of 2 years. Arch Orthop Trauma Surg 2014; 134:1155-62. [PMID: 24595613 DOI: 10.1007/s00402-014-1963-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is currently a trend toward minimally invasive total knee arthroplasty (TKA) to decrease the morbidity related to the standard approach. The aim of our study was to clarify whether the mini-subvastus surgical had an advantage over the standard in term of pain level, blood loss, and postoperative recovery, whether the mini-subvastus surgical was prone to radiographic malalignment, prolonged operative time, and increased complications. METHODS In a prospective randomized study, we compared the clinical and radiological results of primary TKA using a mini-subvastus approach or a standard approach in 68 patients. The mini-subvastus approach was used on 35 patients (group I) and the standard approach on 33 patients (group II). RESULTS The mean follow-up was 28 months (range 24-36 months). Patients in group I had less blood loss and better visual analogue scale score at 1 day postoperatively. They achieved active straight leg raise earlier and underwent less lateral retinacular releases. The mean Knee Society function score, Oxford knee score, and range of movement were significantly better in group I up to 9 months after surgery (all, p < 0.05). However, there were no significant differences in these parameters between the groups at final follow-up. Reduced access and visibility in group I prolonged tourniquet time by an average of 22 min and resulted in five technical errors on radiographic evaluation. CONCLUSIONS Patients can receive marked but temporary benefits from the mini-subvastus technique, with a definite cost: that of component malposition and prolongation of operative time.
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Orth P, Rey-Rico A, Venkatesan JK, Madry H, Cucchiarini M. Current perspectives in stem cell research for knee cartilage repair. STEM CELLS AND CLONING-ADVANCES AND APPLICATIONS 2014; 7:1-17. [PMID: 24520197 PMCID: PMC3897321 DOI: 10.2147/sccaa.s42880] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Protocols based on the delivery of stem cells are currently applied in patients, showing encouraging results for the treatment of articular cartilage lesions (focal defects, osteoarthritis). Yet, restoration of a fully functional cartilage surface (native structural organization and mechanical functions) especially in the knee joint has not been reported to date, showing the need for improved designs of clinical trials. Various sources of progenitor cells are now available, originating from adult tissues but also from embryonic or reprogrammed tissues, most of which have already been evaluated for their chondrogenic potential in culture and for their reparative properties in vivo upon implantation in relevant animal models of cartilage lesions. Nevertheless, particular attention will be needed regarding their safe clinical use and their potential to form a cartilaginous repair tissue of proper quality and functionality in the patient. Possible improvements may reside in the use of biological supplements in accordance with regulations, while some challenges remain in establishing standardized, effective procedures in the clinics.
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Affiliation(s)
- Patrick Orth
- Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany
| | - Ana Rey-Rico
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Germany
| | - Jagadeesh K Venkatesan
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Germany
| | - Henning Madry
- Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany ; Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Germany
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Germany
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Zhang Z, Gu B, Zhu W, Zhu L, Li Q, Du Y. Minimal invasive and computer-assisted total knee replacement compared with the minimal invasive technique: a prospective, randomized trial with short-term outcomes. Arch Orthop Trauma Surg 2014; 134:65-71. [PMID: 24202408 DOI: 10.1007/s00402-013-1879-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Up to now, no prospective, randomized comparisons between minimal invasive and computer-assisted total knee arthroplasty (MICA-TKA), and minimal invasive technique (MI-TKA) has been documented to evaluate not only clinical, but also radiologic results of the MICA-TKA. This prospective, randomized study was performed to compare the short-term results of MICA-TKA with minimal invasive technique MI-TKA for 6-month follow-up. PATIENTS AND METHODS We reported the clinical and radiological results of 80 subjects who had cruciate-substituting, TKA-implanted primary total knee arthroplasties using either minimal invasive and computer-assisted technique (40 patients Group I) or minimal invasive technique (40 patients, Group II). Tourniquet time, length of skin incision, and total blood loss were compared. Knee society scores (KSSs), knee society functional scores (KSFSs), range of motion (ROM), and radiographic results were assessed and reported preoperatively and at 6-month follow-up. RESULTS The accuracy of the implantations in relation to the coronal mechanical axis in Group I was superior to that of Group II (P < 0.05). The femoral rotational profile revealed the prosthesis in Group I that was implanted with significantly less internal rotation than in Group II. The average blood loss in patients of Group I was significantly reduced as compared to patients of Group II. No significant difference was detected in terms of tourniquet time or length of skin incision. Clinical results, with regard to ROMs and KSSs, as well as KSFSs were equally good in both the groups. CONCLUSIONS Better alignment and similarity of good clinical results at short-term follow-up may provide subjects who receive MICA-TKA with long-term endurance of their implants. Further studies on longer-term outcomes and functional improvements are required to validate these possibilities.
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Affiliation(s)
- Zhenxiang Zhang
- Orthopedic Department, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, 225300, Jiangsu, People's Republic of China,
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Meena S, Palaniswamy A, Chowdhury B. Web-based information on minimally invasive total knee arthroplasty. J Orthop Surg (Hong Kong) 2013; 21:305-7. [PMID: 24366789 DOI: 10.1177/230949901302100308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate information available on the internet regarding minimally invasive total knee arthroplasty (TKA). METHODS The 3 most popular search engines (Google, Yahoo, and MSN) were used to search the keyword 'minimally invasive knee replacement'. The top 50 websites from each search engine were evaluated for authorship and contents; duplicate websites were not double-counted. RESULTS Of the 150 websites, 51% were authored by a hospital/university, 26% by private medical groups, 14% were news stories, and 9% were from orthopaedic industry sources. 73% offered the opportunity to make an appointment. 18% described the surgical technique, whereas only 9% explained patient eligibility. 25% described the risks, whereas only 3% made reference to peer-reviewed publications. >82% made specific claims regarding the advantages of minimally invasive surgery. CONCLUSION Most websites providing minimally invasive TKA information were insufficient in terms of explaining surgical technique, patient eligibility, and assoicated risks.
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Affiliation(s)
- Sanjay Meena
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Minimally invasive and computer-assisted total knee arthroplasty versus conventional technique: a prospective, randomized study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1475-9. [PMID: 24052416 DOI: 10.1007/s00590-013-1313-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
We conducted a prospective, randomized study to compare the short-term results of minimally invasive and computer-assisted total knee arthroplasty (MICA-TKA) with those of conventional total knee arthroplasty (C-TKA) for 12-month follow-up. A total of 87 subjects who met the inclusion and exclusion criteria of the study were prospectively randomized consecutively into two groups: the C-TKA group (Group A, n = 44) and the MICA-TKA technique (Group B, n = 43). All the operations were performed by the same senior surgeon. Before surgery and at follow-up, patients were evaluated by the same observer. Tourniquet time as well as total blood loss was compared. Knee Society scores (KSSs), Knee Society functional scores (KSFSs), range of motion (ROM), and radiographic results were assessed and reported preoperatively and at 12-month follow-up. Of these patients, 82 (Group A 42; Group B 40) were available for 12-month evaluation. The two groups were found to be similar in terms of coronal mechanical axis. Similarly, the femoral rotational profile revealed that the prosthesis in Group A was implanted with similar internal rotation to Group B. The average blood loss in patients of Group B was significantly reduced as compared to patients of Group A. No significant difference was detected in terms of tourniquet time. Clinical results in Group B, with regard to ROMs and KSSs, as well as KSFSs were significantly superior to that in Group A. Based on the results obtained from this study, it is demonstrated that MICA-TKA leads to a similarly accurate restoration of leg alignment and component orientation compared to the C-TKA. Moreover, MICA-TKA produces superior clinical results to that of C-TKA. However, there is clearly a need for additional high-quality clinical trials with long-term follow-up to confirm the clinical benefits of MICA-TKA.
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Lin SY, Chen CH, Fu YC, Huang PJ, Lu CC, Su JY, Chang JK, Huang HT. Comparison of the clinical and radiological outcomes of three minimally invasive techniques for total knee replacement at two years. Bone Joint J 2013; 95-B:906-10. [PMID: 23814241 DOI: 10.1302/0301-620x.95b7.29694] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Minimally invasive total knee replacement (MIS-TKR) has been reported to have better early recovery than conventional TKR. Quadriceps-sparing (QS) TKR is the least invasive MIS procedure, but it is technically demanding with higher reported rates of complications and outliers. This study was designed to compare the early clinical and radiological outcomes of TKR performed by an experienced surgeon using the QS approach with or without navigational assistance (NA), or using a mini-medial parapatellar (MP) approach. In all, 100 patients completed a minimum two-year follow-up: 30 in the NA-QS group, 35 in the QS group, and 35 in the MP group. There were no significant differences in clinical outcome in terms of ability to perform a straight-leg raise at 24 hours (p = 0.700), knee score (p = 0.952), functional score (p = 0.229) and range of movement (p = 0.732) among the groups. The number of outliers for all three radiological parameters of mechanical axis, frontal femoral component alignment and frontal tibial component alignment was significantly lower in the NA-QS group than in the QS group (p = 0.008), but no outlier was found in the MP group. In conclusion, even after the surgeon completed a substantial number of cases before the commencement of this study, the supplementary intra-operative use of computer-assisted navigation with QS-TKR still gave inferior radiological results and longer operating time, with a similar outcome at two years when compared with a MP approach.
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Affiliation(s)
- S-Y Lin
- Kaohsiung Municipal Ta-Tung Hospital, Department of Orthopaedics, Kaohsiung Medical University, No. 68 ZhongHua 3rd Rd, Cianjin District, Kaohsiung, Taiwan
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Zhang Z, Zhu W, Gu B, Zhu L, Chen C. Mini-midvastus versus mini-medial parapatellar approach in total knee arthroplasty: a prospective, randomized study. Arch Orthop Trauma Surg 2013; 133:389-95. [PMID: 23229457 DOI: 10.1007/s00402-012-1645-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To date, no English literature has evaluated the short-term results of the mini-medial parapatellar approach compared with the mini-midvastus approach. This prospective, randomized study was performed to compare the short-term results of total knee arthroplasty using either a mini-midvastus or a mini-medial parapatellar approach. PATIENTS AND METHODS We reported the clinical and radiological results of 89 patients who had primary total knee arthroplasties with minimally invasive techniques using either a mini-midvastus or a mini-medial parapatellar approach. The mini-midvastus approach was used on 45 patients (group I) and a mini-medial parapatellar approach on 44 patients (group II). Skin incision length, tourniquet time, incidence of lateral retinacular release, total blood loss, straight leg raising time, visual analogy scale score, alignment of the knee, component position, and complication of each group were examined. Knee Society scores, range of motion were compared at 7 days, 6 weeks, 3 months, and 6 months postoperatively. RESULTS The mean tourniquet time was 68 min in group I, significantly longer than 56 min for group II. However, comparisons of postoperative knee scores and function scores between both approaches did not yield a significant difference in outcome. No significant difference was found with respect to total blood loss, visual analogy scale score, straight-leg-raising test, range of motion or radiographic findings. CONCLUSION Based on these results, we believe that the early results are similar between mini-midvastus and mini-medial parapatellar approach, ultimately the selection of the surgical approach will depend on the surgeon's experience and preference.
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Affiliation(s)
- Zhenxiang Zhang
- Orthopedic Department, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu, People's Republic of China.
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Chiang H, Lee CC, Lin WP, Jiang CC. Comparison of quadriceps-sparing minimally invasive and medial parapatellar total knee arthroplasty: a 2-year follow-up study. J Formos Med Assoc 2012; 111:698-704. [PMID: 23265749 DOI: 10.1016/j.jfma.2011.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 08/08/2011] [Accepted: 11/18/2011] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/PURPOSE Quadriceps-sparing minimally invasive total knee arthroplasty (TKA) has been proposed to limit surgical dissection without compromising surgical outcome. We conducted a prospective and randomized study to compare the outcomes of patients who underwent quadriceps-sparing TKA with the outcomes of those who underwent standard medial parapatellar TKA, after a 2-year follow-up period. METHODS Eighty primary TKA procedures that were to be performed in 60 osteoarthritis patients were randomly assigned to either a quadriceps-sparing (40 knees) or a standard medial parapatellar (40 knees) group. All surgeries were designed to set the prosthesis with a femoral component alignment of 7° valgus and a tibial component alignment that was perpendicular to the tibial shaft. Surgical time and tourniquet time were recorded. Outcome variables included knee function, as defined by a hospital for special surgery knee score; quadriceps muscle strength, which was measured by an isokinetic dynamometer; pain, as indicated on a visual analog scale; prosthetic position, which was measured on plain radiograph; and range of motion. RESULTS Patients who underwent the 38 quadriceps-sparing and 37 standard TKA procedures completed the 2-year follow-up period without any infection or revision. The mean surgical time and tourniquet time were significantly longer in the quadriceps-sparing group. The mean peak quadriceps muscle strength, hamstring muscle strength, normalized muscle balance (hamstring/quadriceps ratio), pain score, function score, and range of motion were comparable in both groups at 2 months and 2 years. In the quadriceps-sparing group, both the femoral and the tibial components were significantly more varus-deviated from the expected position. CONCLUSIONS Patients undergoing quadriceps-sparing and standard medial parapatellar TKA had comparable outcomes for quadriceps muscle strength, hamstring-quadriceps balance, and knee function; however, the quadriceps-sparing TKA was more time consuming surgically and resulted in a less accurate prosthesis position.
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Affiliation(s)
- Hongsen Chiang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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26
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Learning curve of the limited subvastus approach in minimally invasive surgery in total knee replacement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recote.2011.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Curva de aprendizaje de la cirugía mínimamente invasiva tipo subvasto limitado en la prótesis total de rodilla. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2011.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Unger AS, Duggan JP. Midterm results of a porous tantalum monoblock tibia component clinical and radiographic results of 108 knees. J Arthroplasty 2011; 26:855-60. [PMID: 21036009 DOI: 10.1016/j.arth.2010.08.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 08/25/2010] [Indexed: 02/01/2023] Open
Abstract
The use of Trabecular Metal (TM), a biomaterial manufactured from elemental tantalum metal, has recently increased in orthopedics. One hundred eight consecutive TM monoblock tibias were implanted in 95 patients and followed for a minimum of 2 years. The average follow-up was 4.5 years. The average age was 65 years. The Knee Society score of 36 improved to 89. One hundred five of the knees were rated good/excellent, and 3 knees were rated poor. Two patellar revisions were performed for loose components and one for patellar misalignment. One patella fracture required open reduction and internal fixation. One femur was revised. There were no tibia revisions. There were no progressive radiographic lucencies. Midterm clinical and radiographic results of 108 consecutive TM tibia components have a high rate of success.
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Affiliation(s)
- Anthony S Unger
- Department Orthopedic Surgery, George Washington University,Washington, DC, USA
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Lee MSL, Yim MCWS, Wages JJ, Nakasone CK. Component alignment after minimally invasive total knee arthroplasty: results of the first 100 cases performed. J Arthroplasty 2011; 26:926-30. [PMID: 21036010 DOI: 10.1016/j.arth.2010.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 08/26/2010] [Indexed: 02/01/2023] Open
Abstract
It has been suggested that minimally invasive total knee arthroplasties increase the risk of component malalignment. Results during the period of initial learning curve on component malalignment are relatively unknown but should be addressed. This study reports the component alignment data of the first 100 minimally invasive total knee arthroplasties performed by a single surgeon from the very start of a community-based practice immediately after fellowship training. The results indicate that the initial learning curve produces results comparable to reported results of standard total knee arthroplasties.
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Affiliation(s)
- Matthew S L Lee
- The Bone and Joint Center at Straub, Straub Clinic and Hospital, Honolulu, HI 96813, USA
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30
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Zhang XL, Cheng T, Zeng BF. Experts' consensus on minimally invasive surgery for total joint arthroplasty. Orthop Surg 2011; 3:147-51. [PMID: 22009643 PMCID: PMC6583118 DOI: 10.1111/j.1757-7861.2011.00134.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 02/10/2011] [Indexed: 11/27/2022] Open
Affiliation(s)
- Xian-long Zhang
- Department of Orthopaedic Surgery, The Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Does tranexamic acid save blood in minimally invasive total knee arthroplasty? Clin Orthop Relat Res 2011; 469:1995-2002. [PMID: 21286886 PMCID: PMC3111781 DOI: 10.1007/s11999-011-1789-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 01/14/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tranexamic acid (TEA) reportedly reduces perioperative blood loss in TKA. However, whether it does so in minimally invasive TKA is not clear. QUESTIONS/PURPOSES We asked whether TEA would reduce blood loss and blood transfusion requirements after minimally invasive TKA. PATIENTS AND METHODS We prospectively enrolled 100 patients who underwent minimally invasive TKAs: 50 received one intravenous injection of TEA before deflation of the tourniquet and a control group of 50 patients received an equivalent volume of placebo. We compared changes in hemoglobin, postoperative drainage, total blood loss, and transfusion rates between the two groups. RESULTS The total blood loss was less for patients in the TEA group than for the control group: 833 mL (374-1014 mL) versus 1453 mL (733-2537 mL), respectively. The rate of blood transfusion also was less for patients in the TEA group than in the control group (4% versus 20%). The hemoglobin levels on the second and fourth postoperative days were greater for patients in the TEA group than in the control group. CONCLUSIONS Our data suggest one intraoperative injection of TEA decreased the total blood loss and need for transfusion after minimally invasive TKA. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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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 2011; 19:66-73. [PMID: 20390249 DOI: 10.1007/s00167-010-1130-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 03/12/2010] [Indexed: 10/19/2022]
Abstract
Patients desire less pain and faster recovery of range of knee motion after total knee arthroplasty (TKA). While minimal invasive surgery (MIS) TKA appears to meet these needs, concerns exist regarding component malpositioning. Navigation systems can reduce the incidence of component misalignment. The present prospective randomized study compared limited medial parapatellar (LMPP) and mini-midvastus (MMV) approaches in 30 patients who had bilateral simultaneous primary TKAs. Each patient underwent LMPP on one knee and MMV on the other. Both approaches were navigation-assisted. We primarily analyzed postoperative pain (using visual analog scores), range of knee motion, and hospital for special surgery (HSS) scores in the first 6 postoperative months (i.e., the early postoperative period), and secondarily analyzed perioperative parameters and radiographic outcomes. The LMPP and MMV approaches were found to be similar in terms of pain measured at postoperative 3 days, 1, 2 weeks, 1, 3, and 6 months (P = NS). Similarly, the 2 approaches were found to be similar in terms of range of motion measured at 1, 2 weeks, 1, 3, and 6 months (P = NS), and in terms of HSS scores measured at 1, 3, and 6 months (P = NS). There were also no differences between groups in terms of total blood loss, approach preferred by patients, and radiographic component positioning. The present study found that navigation-assisted MMV and navigation-assisted LMPP resulted in similar outcomes in terms of pain, ROM, HSS score, and radiologic outcomes over the first six postoperative months. We recommend the LMPP approach over the MMV approach in navigation-assisted MIS TKA because it is more familiar to surgeons and is easier to convert to the conventional approach where necessary.
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Gandhi R, Smith H, Lefaivre KA, Davey JR, Mahomed NN. Complications after minimally invasive total knee arthroplasty as compared with traditional incision techniques: a meta-analysis. J Arthroplasty 2011; 26:29-35. [PMID: 20149577 DOI: 10.1016/j.arth.2009.11.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 11/25/2009] [Indexed: 02/01/2023] Open
Abstract
The primary objective of our meta-analysis was to compare the incidence of complications between minimally invasive surgery and standard total knee arthroplasty (TKA) approaches. We reviewed randomized controlled trials comparing minimally invasive TKA to standard TKA. After testing for publication bias and heterogeneity, the data were aggregated by random effects modeling. Our primary outcome was the number of complications. Our secondary outcomes were alignment outliers, Knee Society Function scores, and Knee Society Knee scores. The combined odds ratios for complications for the minimally invasive surgery group and alignment outliers were 1.58 (95% confidence interval, 1.01-2.47; P < .05) and 0.79 (95% confidence interval, 0.34-1.82; P = .58), respectively. The standard difference in means for Knee Society scores was no different between groups. Minimally invasive knee surgery should be approached with caution.
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Affiliation(s)
- Rajiv Gandhi
- Division of Orthopaedic Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
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35
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Patella Eversion Reduces Early Knee Range of Motion and Muscle Torque Recovery after Total Knee Arthroplasty: Comparison between Minimally Invasive Total Knee Arthroplasty and Conventional Total Knee Arthroplasty. ARTHRITIS 2010; 2011:854651. [PMID: 22046526 PMCID: PMC3195321 DOI: 10.1155/2011/854651] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 10/26/2010] [Accepted: 11/30/2010] [Indexed: 01/13/2023]
Abstract
We hypothesized that patella eversion during total knee arthroplasty (TKA) reduces early return of active knee extension and flexion, quadriceps muscle strength, and postoperative pain. In 100 conventional TKA knees and 100 minimally invasive TKA (MIS TKA) knees, we compared knee range of motion (ROM), postoperative pain, and quadriceps muscle strength at 1 day, 4 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 12 weeks, 1 year, and 5 years after surgery. The differences of surgical approach between MIS TKA and conventional TKA of this study are length of skin incision with subcutaneal flap and patella eversion. In MIS TKA, skin incision is shorter than conventional TKA. Furthermore, patella is not everted in MIS TKA procedure. There were no significant differences in preoperative factors. Postoperative improvement of ROM, postoperative muscle strength recovery, and postoperative improvement of visual analog scale were faster in patients with MIS TKA when compared to that in patients with conventional TKA. On the other hand, no significant difference was observed in complication, 5-year clinical results of subjective knee function score, and the postoperative component angle and lower leg alignment. These results indicate that patella eversion may affect muscle strength recovery and postoperative pain.
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Chalidis BE, Petsatodis G, Christodoulou AG, Christoforidis J, Papadopoulos PP, Pournaras J. Is obesity a contraindication for minimal invasive total knee replacement? A prospective randomized control trial. Obes Surg 2010; 20:1633-1641. [PMID: 19756888 DOI: 10.1007/s11695-009-9968-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 08/27/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although total knee replacement (TKR) has been proven a very successful treatment modality for the end-stage knee osteoarthritis (OA) in obese patients, the rehabilitation period often is long and painful. Minimal invasive surgery (MIS) has gained much attention in TKR promising fast and less painful recovery. However, little is known about the effectiveness of the technique in the obese adult population. METHODS One hundred consecutive patients with body mass index (BMI) > 30 kg/m(2) and tricompartmental knee OA were randomly assigned to undergo either standard TKR (50 patients) or MIS-TKR (50 patients). The patients were assessed clinically and radiologically before the procedure and at subsequent postoperative follow-up visits, until 2 years after the operation. RESULTS Knee society function and pain scores were significantly higher in MIS group for 3 months following surgery. Patients after MIS had also lower levels of pain during hospitalization. Tourniquet time was on average 7 min longer during MIS-TKR (p = 0.03) but operative time was almost equal in both groups (p = 0.11). No statistical significant difference was found between groups regarding the amount of blood loss (p = 0.49) or incidence of allogeneic blood transfusion (p = 0.27). Active straight leg raising was achieved 2.2 days earlier, on average, after MIS-TKR (p < 0.001). No severe complications or residual coronal and sagittal imbalance were identified. Component alignment was in normal limits and similar in both groups. In MIS group, higher BMI did not have a negative predictive effect on knee pain and function. CONCLUSIONS MIS is a reliable and safe option in obese patients undergoing TKR regardless the level of BMI. It is associated with improved early clinical outcome without sacrificing radiographic positioning of the implants.
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Affiliation(s)
- Byron E Chalidis
- 1st Orthopaedic Department, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Pan WM, Li XG, Tang TS, Qian ZL, Zhang Q, Zhang CM. Mini-subvastus versus a standard approach in total knee arthroplasty: a prospective, randomized, controlled study. J Int Med Res 2010; 38:890-900. [PMID: 20819425 DOI: 10.1177/147323001003800315] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This prospective randomized study compared the clinical and radiological results of primary total knee arthropasty (TKA) using a mini-subvastus approach (group I; n = 35) or a standard approach (group II; n = 33). A posterior-stabilized prosthesis was used in both groups by the same surgeon. Mean follow-up was 18 months (range 14 - 26 months). Patients in group I lost less blood and experienced less pain 1 day post-operatively. They achieved an active straight leg raise earlier and underwent less lateral retinacular releases. Functional outcome and the range of knee movements were significantly better in group I up to 9 months post-operatively, but there was no significant difference between the groups at 1 year post-operatively or at final follow-up. Reduced access and visibility in group I prolonged the operation time and resulted in five technical errors on radiographic evaluation. Based on these results, the authors currently only use the mini-subvastus approach for minimally invasive TKA in selected cases.
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Affiliation(s)
- W-M Pan
- Department of Orthopaedic Surgery, First Affiliated Hospital of Suzhou University, Suzhou, China
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38
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Kusuma SK, Wasielewski RC. Gap balancing through small incisions: competing goals. Orthopedics 2010; 33:654. [PMID: 20839672 DOI: 10.3928/01477447-20100722-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Significant controversy exists in the literature regarding the pitfalls and benefits of minimally invasive total knee arthroplasty (TKA). Regardless, most surgeons today use smaller exposures than in previous years. Although more difficult, rigid adherence to classical gap balancing techniques can allow a surgeon to achieve ideal ligament and flexion/extension gap balance in TKA through a minimally invasive approach. There are certain groups of patients (obesity/medical comorbidities/vascular insufficiency) in whom small incision approaches should not be attempted due to increased risks of wound complications. Additionally, achievement of gap balance requires sequential and safe removal of bone starting with the patellar cut, followed by the distal femoral cut, then by the tibial cut, and concluding with completion of the femoral component cuts. Use of special instruments such as protective metal patellar buttons, medial to lateral distal femoral cutting blocks, and low profile spacer blocks can facilitate the surgical process. Accurate femoral component rotation is more difficult in minimally invasive approaches and must be carefully checked. A tight extensor mechanism in flexion can mislead the surgeon to place the femoral component in an internally rotated position. Furthermore, with limited visualization, surgeons must avoid overaggressive ligament releases early in the procedure prior to completion of bone cuts. However, with appropriate patient selection and a systematic approach to minimally invasive total knee arthroplasty, surgeons can continue to achieve ideal ligament balance with a more soft tissue friendly operation.
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Affiliation(s)
- Sharat K Kusuma
- Department of Orthopedic Surgery, Grant Medical Center, Columbus, Ohio, USA.
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Nestor BJ, Toulson CE, Backus SI, Lyman SL, Foote KL, Windsor RE. Mini-midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty. J Arthroplasty 2010; 25:5-11, 11.e1. [PMID: 20541889 DOI: 10.1016/j.arth.2010.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 04/01/2010] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine whether the mini-midvastus approach to total knee arthroplasty (TKA) results in differences in quadriceps muscle strength as well as previously cited advantages in a double blind prospective randomized trial. Twenty-seven patients (54 TKAs) scheduled for bilateral TKA were randomized to undergo mini-midvastus approach on one knee and standard approach on the other. Incision lengths were the same. Postoperative strength was determined by isokinetic and isometric peak torque testing. Range of motion, pain Visual analog scale, side-preference, and gait analysis were assessed preoperatively and postoperatively. The only significant difference in strength testing was increased isokinetic and isometric extension torque at 3 weeks postoperatively for the mini-midvastus approach. No differences between the mini-midvastus and standard approach were observed for stride length, stance time, pain Visual analog scale, or knee range of motion. The mini-midvastus approach has limited benefit compared to the standard approach for TKA.
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Affiliation(s)
- Bryan J Nestor
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York 10021, USA
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40
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Wülker N, Lambermont JP, Sacchetti L, Lazaró JG, Nardi J. A prospective randomized study of minimally invasive total knee arthroplasty compared with conventional surgery. J Bone Joint Surg Am 2010; 92:1584-90. [PMID: 20595563 DOI: 10.2106/jbjs.h.01070] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite intense debate regarding whether minimally invasive techniques for total knee arthroplasty improve clinical outcomes over standard techniques, few prospective randomized trials addressing this debate are available in the literature. We therefore designed this multicenter study to assess the overall safety and effectiveness of a minimally invasive approach without the use of computer navigation in comparison with conventional knee arthroplasty. METHODS We prospectively randomized 134 patients (101 women and thirty-three men, with an average age of 70.1 years) to undergo surgery for total knee arthroplasty with use of either minimally invasive knee instruments (sixty-six patients) or a standard approach (sixty-eight patients). The follow-up period was one year. RESULTS On the basis of our sample size, no significant difference was detected between the groups in any of the relevant clinical areas assessed: total range of motion, Knee Society total and function scores, and visual analog scores for pain and activities of daily living. Patients who underwent minimally invasive surgery had a longer mean surgical time (by 5.6 minutes) and had less mean blood loss (by 17 mL). Radiographic measurements demonstrated reliable implant positioning in both groups. Seven patients in each group had an adverse event related to their procedure. CONCLUSIONS On the basis of the numbers, no significant advantage to minimally invasive total knee arthroplasty over a conventional technique was observed. Greater sample sizes and a longer follow-up period are required to fully determine the long-term safety and efficacy of this minimally invasive surgical technique.
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Affiliation(s)
- N Wülker
- Orthopaedic Department, Tübingen University Hospital, Hoppe-Seyler-Strasse 1-3, 72076 Tübingen, Germany.
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Bonutti PM, Zywiel MG, Ulrich SD, Stroh DA, Seyler TM, Mont MA. A comparison of subvastus and midvastus approaches in minimally invasive total knee arthroplasty. J Bone Joint Surg Am 2010; 92:575-82. [PMID: 20194315 DOI: 10.2106/jbjs.i.00268] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The mini-subvastus and the mini-midvastus approaches are among the most common alternatives to the medial parapatellar approach for total knee arthroplasty. The purpose of this study was to compare the early clinical outcomes of these two approaches. METHODS In this prospective, randomized study of fifty-one patients who underwent bilateral total knee arthroplasty, the mini-subvastus approach was used in one knee and the mini-midvastus approach, in the contralateral knee. There were forty-two women and nine men who had a mean age of seventy years at the time of the index arthroplasties, and they were followed for two years postoperatively. Clinical outcome was assessed and compared with use of the Knee Society pain and function scores, the straight-leg-raising test, range of motion, and isokinetic strength testing. Operating time and blood loss for each approach were also compared. In addition, patients were surveyed concerning which knee they preferred. RESULTS Comparisons of postoperative Knee Society scores between both approaches at the time of the two-year follow-up did not yield a significant difference in outcome. Isokinetic strength testing at twelve weeks postoperatively revealed no significant differences in muscle strength, with a mean extensor peak torque-to-body weight ratio of 0.14 Nm/kg for both groups. No significant difference was found with respect to total blood loss, straight-leg-raising test, range of motion, or patient preference. There was no clinically relevant difference in operative times between the two approaches. CONCLUSIONS The minimally invasive subvastus and midvastus approaches for total knee arthroplasty were both associated with excellent short-term clinical results. Some surgeons believe that the subvastus approach completely avoids damage to the quadriceps mechanism and therefore would be associated with improved muscle function. This prospective series did not identify a substantive difference between the two approaches. We believe that the decision between these surgical approaches should be based on surgeon preference and experience.
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Affiliation(s)
- Peter M Bonutti
- Bonutti Clinic, 1303 West Evergreen Avenue, Effingham, IL 62401, USA
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Abstract
BACKGROUND Mini-subvastus approach for Total Knee Arthropalsty allows a faster recovery. It is traditionally not utilized for obese patients because of difficulty in exposure of the knee and eversion of the patella. We hypothesized that obesity should not really cause a problem for patients undergoing a TKA with the mini-subvastus approach as the anatomy of the quadriceps in the obese and the nonobese patient population is the same. We present an analysis of the use of mini-subvastus approach in obese patients. MATERIALS AND METHODS 97 obese patients (109 knees) 81 females + 16 males with mean age 64 years underwent total knee arthroplasty (TKA) by mini-subvastus approach between January 2006 to July 2007. 16 patients (18 kness) were morbidly obese. All patients were prospectively evaluated by pre- and postoperative Knee Society and function score. The average follow-up was 18 months (range from 1 to 3 years) with minimum 1 year follow-up. RESULTS The approach provided adequate exposure in all knees, with an average surgical time of 90 minutes. The patella could be everted easily after the tibial and femoral cuts. The average Knee Society score improved from 42 to 89 and the function score from 48 to 65. The complications included medial collateral ligament injury (one case) and patellar tendon avulsion (one case). CONCLUSION Our results compare favorably with other reported series in obese patients. The mini-subvastus approach can be considered in obese patients.
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Affiliation(s)
- Nilen Shah
- Consultant Orthopaedic Surgeon, Bombay Hospital, Mumbai, India,Address for correspondence: Dr. Nilen Shah, Flat No. 2, Bldg. No. 2, India House, Kemps Corner, Mumbai - 400 026, India. E-mail:
| | - Nilesh G
- Consultant Orthopaedic Surgeon, Bombay Hospital, Mumbai, India
| | - Narendra Patel
- Consultant Orthopaedic Surgeon, Bombay Hospital, Mumbai, India
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Arnout N, Victor J, Cleppe H, Soenen M, Van Damme G, Bellemans J. Avoidance of patellar eversion improves range of motion after total knee replacement: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2009; 17:1206-10. [PMID: 19585102 DOI: 10.1007/s00167-009-0863-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 06/18/2009] [Indexed: 12/15/2022]
Abstract
Minimally invasive surgery has recently been introduced in TKA surgery. The purpose of this study was to evaluate the effect of eversion of the patella, on safety and functional result after TKA. In a prospective, randomised, double blinded trial, 60 patients were divided in two groups: group A underwent TKA through a standard medial parapatellar arthrotomy, with patellar eversion. Group B underwent the same exposure, except for the fact that the patella was subluxed laterally. All other treatment protocols were identical. Outcomes were measured until 1 year postoperatively. Radiographic evaluation included AP, lateral, skyline and full leg standing radiographs. VAS, WOMAC score, Knee Society Knee and Function score were performed. Active and passive range of motion (ROM) and knee proprioception was measured. All patients underwent isokinetic strength testing. The mean passive ROM changed from 121 degrees preoperatively to 121 degrees postoperatively in group A, compared to 118 degrees -131 degrees respectively in group B at 1 year (P = 0.003). The mean active ROM changed from 112 degrees to 115 degrees in group A, and from 108 degrees to 125 degrees in group B (P = 0.005). All other parameters were not significantly different. Patellar dislocation without eversion for exposing the knee during TKA is a safe procedure and improves ROM at 1 year postoperatively.
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Affiliation(s)
- Nele Arnout
- UZ Pellenberg, Weligerveld 1, Pellenberg 3212, Belgium.
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44
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Khanna A, Gougoulias N, Longo UG, Maffulli N. Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin North Am 2009; 40:479-89, viii. [PMID: 19773053 DOI: 10.1016/j.ocl.2009.05.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The concept of minimally invasive total knee arthroplasty surgery evolved to reduce quadriceps muscle strength loss and improve clinical outcome following total knee replacement. We performed a systematic review of the published literature on Minimally Invasive Total Knee Arthroplasty (MITKA) and analyzed the reported surgical outcomes. Twenty-eight studies published from January 2003 to June 2008 that met the inclusion criteria were evaluated using the modified Coleman Methodology Score (CMS). At a mean CMS of 60, most studies reporting on outcome of MITKA are of moderate scientific quality. Patients undergoing MITKA tend to have decreased postoperative pain, rapid recovery of quadriceps function, reduced blood loss, improved range of motion (mostly reported as a short-term gain) and shorter hospital stay compared with patients undergoing standard total knee arthroplasty. These benefits, however, need to be balanced against the incidence of increased tourniquet time and increased incidence of component malalignment in the MITKA group. So far, the evidence based knowledge regarding results of MITKA comes from prospective studies of moderate quality with short follow up periods. Multicenter studies with longer follow-ups are needed to justify the long-term advantages of MITKA over standard total knee arthroplasty.
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Affiliation(s)
- Anil Khanna
- Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire ST4 7QB, UK
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45
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Lin WP, Lin J, Horng LC, Chang SM, Jiang CC. Quadriceps-sparing, minimal-incision total knee arthroplasty: a comparative study. J Arthroplasty 2009; 24:1024-32. [PMID: 18757172 DOI: 10.1016/j.arth.2008.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 07/09/2008] [Indexed: 02/01/2023] Open
Abstract
Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty (TKA): the minimal-incision medial parapatellar (MP) approach and the quadriceps-sparing (QS) approach with side-cutting instruments. Sixty patients (80 knees) with primary osteoarthritis were randomly assigned to receive MP or QS TKA. Postoperative alignment of the femoral component was significantly less valgus, and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach. One tibial outlier and 3 femoral outliers were observed with QS TKA. The overall postoperative hip-knee-ankle axis was more varus, and surgical time was longer with QS TKA. Short-term isokinetic peak muscle torque, postoperative pain, and functional outcomes did not differ between the approaches.
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Affiliation(s)
- Wei-Peng Lin
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
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46
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Karpman RR, Smith HL. Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty: a prospective, randomized study. J Arthroplasty 2009; 24:681-8. [PMID: 18538536 DOI: 10.1016/j.arth.2008.03.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 03/22/2008] [Indexed: 02/01/2023] Open
Abstract
A prospective, randomized study was performed to compare early clinical and radiographic outcomes of total knee arthroplasty using either standard or minimally invasive surgical approaches. Fifty-nine patients were randomized into 3 groups: a standard median parapatellar incision (n = 19), a "mini mid-vastus" (n = 20), or a "quad sparing" group (n = 20). The procedures were performed by a single surgeon using similar perioperative protocols at 1 hospital. Postoperatively, the quad sparing group demonstrated some statistically significant (P < .05) improvement in week 2 and greater but not in weeks 1 and 6 compared to the other groups. No significant differences occurred regarding postoperative complications or radiographic alignment of the implants. In conclusion, our study demonstrated that the quad sparing group had some improved early results without compromising safety or efficacy.
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Affiliation(s)
- Robert R Karpman
- Caritas Holy Family Hospital, Methuen, Massachusetts 01844-4597, USA
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47
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Minimal incision surgery as a risk factor for early failure of total knee arthroplasty. J Arthroplasty 2009; 24:489-98. [PMID: 19339153 DOI: 10.1016/j.arth.2009.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 02/03/2009] [Indexed: 02/01/2023] Open
Abstract
A consecutive series of revision total knee arthroplasty (TKA) performed at 3 centers by 5 surgeons for a 3-year period was reviewed. Revisions performed for infection and rerevisions were excluded. Review of clinical and radiographic data determined incision type, sex, age, time to revision, and primary diagnosis at time of revision. Two-hundred thirty-seven first-time revision TKAs were performed, of which 44 (18.6%) had been a minimal incision surgery (MIS) primary TKA and 193 (81.4%) had been a standard primary TKA. Patients with MIS were younger (62.1 vs 66.2 years, P = .02). Most striking was the difference in time to revision, which was significantly shorter for the MIS group (14.8 vs 80 months, P < .001). Minimal incision surgery TKA accounted for a substantial percentage of revision TKA in recent years at these centers. The high prevalence of MIS failures occurring within 24 months is disturbing and warrants further investigation.
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Abstract
This study examined whether quadriceps-sparing total knee arthroplasty (TKA) through a minimal medial incision could be performed without an increased risk of complications. Data were collected prospectively on 209 patients who underwent quadriceps-sparing TKA though a median parapatellar approach. Surgical complications included 2 patellar tendon avulsions, 2 lateral collateral ligament ruptures, and 1 medal collateral ligament rupture. Arthrofibrosis occurred in 21 patients (10%) requiring manipulation under anesthesia, and minor wound complications occurred in 22 patients (11%). Unintended cement retention was noted on 16 radiographs (8%). At 6 months of follow-up, Knee Society scores and functional outcomes were unchanged from previous experience with standard TKA. Compared to previous experience with traditional medial parapatellar approaches, the rate of intraoperative complications such as ligament rupture and retention of cement were higher than expected. Complication rates in the second 100 patients who underwent quadriceps-sparing TKA showed no significant difference compared to previous patients who underwent standard TKA. Complications were more common in patients with preoperative peripheral vascular disease, body mass index >33, and valgus deformity >10 degrees ; these patients may not be good candidates for this modified procedure. This quadriceps-sparing technique required a progressive learning curve and has not yet proven to be superior to standard approaches. However, complication rates after extensive experience were not significantly increased.
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Affiliation(s)
- Gabriel Jackson
- Rubin Institute for Advanced Orthopaedics, 2700 Quarry Lake Drive,, Baltimore, MD 21209, USA
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Martin A, Sheinkop MB, Langhenry MM, Oelsch C, Widemschek M, von Strempel A. Accuracy of side-cutting implantation instruments for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2009; 17:374-81. [PMID: 19132345 DOI: 10.1007/s00167-008-0704-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 12/01/2008] [Indexed: 11/30/2022]
Abstract
A new generation of implantation instruments were developed for quadriceps sparing surgical approaches during total knee arthroplasty (TKA). There is little information on the accuracy of the bone cuts performed with the side-cutting technique. A total of 100 patients were randomized to undergo computer-assisted TKA or non-navigated TKA using a mini-subvastus surgical approach and side-cutting implant instrumentation. The radiographic parameters, clinical outcomes and knee scores were evaluated 3 months postoperative. The mechanical axis of the limb was within 3 degrees varus/valgus in 76% of the patients who had navigated procedures versus 66% of patients who had conventional surgery. The tibial slope showed a rate of inaccuracy of 3 degrees or less for 78% of the patients in the navigated total knee arthroplasty group versus 66% of the patients in the conventional group. Clinical outcomes and knee scores were similar in both groups. The navigation technique could not compensate for shortcomings of the implantation instruments.
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Affiliation(s)
- Arno Martin
- Department of Orthopedic Surgery, University Teaching Hospital, Medical University of Innsbruck, Carinagasse 47, 6800 Feldkirch, Austria.
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50
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Wohlrab D, Zeh A, Mendel T, Hein W. [Quadsparing approach in total knee arthroplasty]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2009; 21:25-34. [PMID: 19326065 DOI: 10.1007/s00064-009-1603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Approach to the knee joint for total knee arthroplasty (TKA) with gentle soft-tissue handling. INDICATIONS Primary TKA with range of motion>or=100 degrees, leg axis up to 10 degrees varus or valgus, body weight<100 kg. CONTRAINDICATIONS Contracted knees, leg axis>10 degrees varus or valgus, obesity, previous knee surgery except arthroscopic procedures, rheumatoid arthritis. SURGICAL TECHNIQUE Anterior midline incision. Soft-tissue preparation and capsule incision start at the upper tip of the patella and are continued distally along the medial patellar border ending at the tibial tuberosity. After opening of the joint, the patella is dislocated laterally without everting it. Exposure of the articular surface using a "mobile window". Preparation and insertion of the TKA components using special instruments. Wound closure in layers. POSTOPERATIVE MANAGEMENT Mobilization on crutches with full weight bearing starting on the day of surgery. Daily medical training therapy. Passive motion therapy continued twice a day. Low-dose heparin s.c. for 35 days after surgery. RESULTS In a prospective randomized clinical study, 50 patients with a quadsparing (QS) approach were observed up to 3 months after surgery. In three patients, the use of large femoral components required an extended approach. During the hospital stay knee flexion was significantly greater in patients with the QS approach than in patients with the standard procedure (midvastus approach). There were no differences in implant positioning, Knee Society Score and complication rate between both groups. Use of the QS approach prolonged the duration of surgery by 25 min.
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Affiliation(s)
- David Wohlrab
- Zentrum für Erkrankungen der Haltungs- und Bewegungsorgane, Klinik und Poliklinik für Orthopädie und Physikalische Medizin, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle.
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