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1
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Rosenberg N. Walking Ability After Total Knee Arthroplasty: A Comprehensive Review. Cureus 2025; 17:e79577. [PMID: 40151712 PMCID: PMC11947503 DOI: 10.7759/cureus.79577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2025] [Indexed: 03/29/2025] Open
Abstract
Total knee arthroplasty (TKA) is a highly effective surgical intervention for alleviating pain and restoring function in patients with end-stage knee osteoarthritis. Walking ability, a critical measure of post-operative success, directly impacts patients' independence, mobility, and quality of life. This review comprehensively examines the factors influencing walking ability after TKA, encompassing pre-operative, surgical, and post-operative considerations. Pre-operative factors, such as patient demographics, functional status, psychological well-being, and comorbidities, significantly shape post-operative outcomes. Surgical techniques, including the choice of approach, implant design, alignment, and minimally invasive or robotic-assisted methods, also play a pivotal role in determining walking ability. Post-operative rehabilitation, particularly early mobilization, physical therapy, and exercise protocol adherence, is essential for optimizing recovery. Long-term outcomes reveal that, while most patients experience significant improvements in walking ability, some face persistent limitations due to age, comorbidities, or suboptimal surgical results. Emerging technologies, such as wearable devices, robotic-assisted surgery, and personalized rehabilitation programs, offer promising avenues for enhancing post-operative walking ability. Biological augmentation techniques, like platelet-rich plasma and stem cell therapy, are also being explored to improve tissue healing and functional recovery. This review underscores the importance of a multidisciplinary, patient-centered approach to maximize walking ability and overall satisfaction after TKA, synthesizing evidence from clinical studies, meta-analyses, and systematic reviews. Future research should focus on refining surgical techniques, advancing rehabilitation strategies, and integrating personalized medicine to improve outcomes.
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Affiliation(s)
- Nahum Rosenberg
- Specialists Center, National Insurance Institute - Israel, Haifa, ISR
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2
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Buchalter DB, Ast MP. Avoiding complications in medial unicompartmental knee arthroplasty. J ISAKOS 2024; 9:100331. [PMID: 39401700 DOI: 10.1016/j.jisako.2024.100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 09/25/2024] [Indexed: 11/18/2024]
Abstract
Medial unicompartmental knee arthroplasty (mUKA) is a highly effective treatment for the management of isolated osteoarthritis in the medial compartment. While favorable long-term survivorship is seen in most series, the long-term rate of revision after mUKAs remains higher than that for total knee arthroplasty. Poor indications and poor surgical technique are often responsible for mUKA failure. Understanding why these complications occur and how to avoid them will optimize clinical outcomes, reduce revision rates, and lead to lower healthcare costs. This review will discuss the five most common causes of mUKA failure including progression of arthritis, aseptic loosening, bearing dislocation, periprosthetic fracture, and polyethylene wear and how to avoid them with proper patient selection and meticulous surgical technique.
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Affiliation(s)
- Daniel B Buchalter
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
| | - Michael P Ast
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
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3
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Hosseini‐Monfared P, Mirahmadi A, Amiri S, Minaie R, Ghafouri MH, Kazemi SM. Comparable long-term functional outcomes of subvastus and medial parapatellar approach in total knee arthroplasty: A 10-year follow-up study. J Exp Orthop 2024; 11:e70035. [PMID: 39380847 PMCID: PMC11460747 DOI: 10.1002/jeo2.70035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 10/10/2024] Open
Abstract
Background Surgeons usually use the medial parapatellar or subvastus approaches for total knee arthroplasty (TKA). The subvastus approach is rapidly gaining recognition to reduce damage to the extensional mechanism and recover faster after surgery. This study compares the long-term outcomes of the conventional medial parapatellar and subvastus approaches in primary TKA during a minimum 10-year follow-up. Methods In a retrospective longitudinal follow-up study from 2008 to 2013, 60 eligible patients for primary TKA were included. The patients were divided into two groups: one undergoing TKA with the subvastus approach (n = 30) and the other with the conventional medial parapatellar approach (n = 30). Postoperatively, the patients were followed up for 10-15 years. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Visual Analogue Scale index for pain. Results The time required to perform an active straight leg raise (SLR) was significantly shorter in the subvastus group (p < 0.001) at early postoperation evaluation. Patients in the subvastus group had lower pain and better knee functional scores at the one-year follow-up (p < 0.05). There was no difference between the two groups regarding duration of hospitalisation, blood loss, operation time, length of the scar, and postoperative complications. Both approaches had similar long-term results regarding pain and functional scores of WOMAC (6.2 ± 1.2 vs. 6.3 ± 1.3, p-value = 0.69) and KSS scores (93.1 ± 6.8 vs. 95.0 ± 3.2, p-value = 0.42). Conclusion The subvastus approach was associated with a shorter time to achieve active SLR, higher functional scores, and better pain relief at early postoperative evaluations. However, both techniques had similar long-term outcomes in terms of pain and functional scores, as measured by the WOMAC and KSS scales. Level of Evidence II.
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Affiliation(s)
- Pooya Hosseini‐Monfared
- Bone Joint and Related Tissues Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Alireza Mirahmadi
- Bone Joint and Related Tissues Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Shayan Amiri
- Shohadaye Haftom‐e‐Tir HospitalIran University of Medical SciencesTehranIran
| | - Reza Minaie
- Bone Joint and Related Tissues Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Hossein Ghafouri
- Bone Joint and Related Tissues Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Seyed Morteza Kazemi
- Bone Joint and Related Tissues Research CenterShahid Beheshti University of Medical SciencesTehranIran
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van Langeveld SJ, Janssen SJ, Koenraadt KLM, Elmans LHGJ, van Steenbergen LN, van Geenen RCI. Reduced 5-Year Risk for Revision of the Oxford UKA Using New Instrumentation versus Conventional Instrumentation: A Registry Study of 12,867 UKAs. J Knee Surg 2023; 36:1447-1453. [PMID: 36122694 DOI: 10.1055/a-1946-6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Microplasty instrumentation was introduced for a more consistent surgical implantation technique, especially component alignment and tibial resection level, of the Oxford medial unicompartmental knee arthroplasty (UKA) and thereby aims to improve UKA survival. This study aimed to assess the 5-year risk for revision and reasons for revision of the Oxford medial UKA using the new instrumentation (Microplasty) with its predecessor, that is, conventional instrumentation (Phase 3). Data of all medial UKAs from the Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten) between 2007 and 2019 were collected. Type of instrumentation was divided into new (Microplasty) and conventional instrumentation. Kaplan-Meier analysis was performed to calculate 5-year cumulative revision percentage with any reason for revision as end point. A multivariable Cox regression with outcome revision of UKA adjusted for age, gender, American Society of Anesthesiologists score, surgical history, and type of fixation was performed. Additionally, reasons for revision at 3-year were assessed and tested through Fisher's exact tests. A total of 12,867 Oxford medial UKAs, 8,170 using new and 4,697 using conventional instrumentation, were included. The 5-year revision percentage was 9.2% (95% confidence interval [CI]: 8.4-10.1%) for UKAs using the conventional and 6.1% (95% CI: 5.4-6.7%) for new instrumentation. The adjusted hazard ratio for revision at 5-year follow-up was 0.74 (95% CI: 0.63-0.87) in favor of UKAs using the new instrumentation. Malalignment was more frequently registered as reason for revision in UKAs using the conventional compared with the new instrumentation (16% versus 7.5%; p = 0.001). Our results show a reduced 5-year risk for revision of the medial Oxford UKAs using the new compared with the conventional instrumentation. This might be the result of a lower revision rate for malalignment in UKAs using the new instrumentation.
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Affiliation(s)
- Stephan J van Langeveld
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Koen L M Koenraadt
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | - Leon H G J Elmans
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
| | | | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care and Education), Amphia Hospital, Breda, The Netherlands
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5
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Yen SH, Lin PC, Wang JW. Comparison of the radiographic outcomes and total blood loss between pinless navigation and conventional method in minimally invasive total knee arthroplasty. J Orthop Surg Res 2023; 18:254. [PMID: 36978115 PMCID: PMC10043515 DOI: 10.1186/s13018-023-03534-w] [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] [Received: 08/16/2022] [Accepted: 01/12/2023] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Computer-assisted surgical navigation has been used in total knee arthroplasty (TKA) procedures for years trying to the accuracy of prosthesis placement. We conducted this prospective randomized clinical trial to compare the accuracy of the radiographic parameters of the prosthesis, total blood loss (TBL), and related complications, between a new pinless navigation system (Stryker OrthoMap Express Knee Navigation) and conventional method in patients undergoing minimally invasive (MIS) TKA procedures.
Patient and methods
A consecutive series of 100 patients underwent unilateral primary TKA were randomly assigned into two groups: navigation group and convention group. The radiographic parameters of the knee implant and the alignment of lower limb were measured at 3 months after surgery. TBL was calculated according to Nadler’s method. The duplex ultrasonography of both lower limbs was performed in all patients to detect the presence of deep-vein thrombosis (DVT).
Results
Totally, 94 patients have completed the radiographic measures. Only the coronal femoral component angle in the navigation group (89.12° ± 1.83°) had significant differences from that in the convention group (90.09° ± 2.18°) (p = 0.022). There were no differences in the rate of outliers. The mean TBL in the navigation group was 841 ± 267 mL, which was similar to that in the convention group at 860 ± 266 mL (p = 0.721). Postoperative DVT risk did not differ between the two groups (2% vs. 0%, p = 0.315).
Conclusion
This pinless navigation TKA showed a comparable acceptable alignment compared with conventional MIS-TKA. There were no differences regarding postoperative TBL between the two groups.
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Nakano N, Mizuno K, Takayama K, Hayashi S, Kuroda R, Matsumoto T. Outcomes of total knee replacement with the use of a NexGen MIS Tibial Component (Mini-keel) : a systematic review. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
NexGen MIS Tibial Component (Mini-keel) is a tibial component specially developed for minimally invasive surgery in total knee replacement (TKR), and the size limitations of its design and the modular system could affect tibial fixation strength, however, this has not been precisely evaluated thus far. This study aimed to systematically review the literature describing the outcome following TKR with the use of a Mini-keel. Electronic searches of databases were undertaken in July 2019 by two experienced orthopaedic surgeons according to the PRISMA guidelines for literature describing the outcomes of TKR with the use of a Mini-keel. Quality of studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The initial search found a total of 623 studies from all the databases. Seven studies met all the inclusion criteria and were eligible for critical appraisal and quality assessment. In total, 2,198 cases were included in the systematic review.
Thirty-five revision cases due to aseptic loosening were found from the systematic review. Two studies were negative about using a Mini-keel and three studies were positive about it, while the other two studies did not judge the quality of a Mini-keel. There have been conflicting conclusions among studies for the use of a Mini-keel.
There remains a paucity of prospective cohort studies between TKRs with the use of a Mini-keel and those with the use of a conventional implant, which makes it difficult to determine the usefulness and reliability of this implant.
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7
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Nadeem S, Mundi R, Chaudhry H. Surgery-related predictors of kneeling ability following total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Relat Res 2021; 33:36. [PMID: 34600595 PMCID: PMC8487473 DOI: 10.1186/s43019-021-00117-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/14/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose Kneeling ability is among the poorest outcomes following total knee arthroplasty (TKA). The purpose of this meta-analysis was to: (1) quantify kneeling ability after TKA; (2) identify surgical approaches and prosthesis designs that improve kneeling ability following TKA; and (3) quantify the effectiveness of these approaches.
Methods We performed a systematic review in accordance with the PRISMA guidelines of multiple medical databases. Data relating to demographics, TKA technique, prosthesis design, and kneeling-specific outcomes were extracted. Comparative outcomes data were pooled using a random effects model. Results Thirty-six studies met the eligibility criteria. The proportion of patients able to kneel increased with longer follow-up (36.8% at a minimum of 1 year follow-up versus 47.6% after a minimum of 3 years follow-up, p < 0.001). The odds of kneeling were greater for patients undergoing an anterolateral incision compared with an anteromedial incision (OR 3.0, 95% CI 1.3–6.9, p = 0.02); a transverse incision compared with a longitudinal incision (OR 3.5, 95% CI 1.4–8.7, p = 0.008); and a shorter incision compared with a longer incision (OR 8.5, 95% CI 2.3–30.9, p = 0.001). The odds of kneeling were worse for a mobile prosthesis compared with a fixed platform design (OR 0.3, 95% CI 0.1–0.7, p = 0.005). Conclusion A large majority of patients are unable to kneel following TKA, although the ability to kneel improves over time. This evidence may facilitate preoperative patient counseling. Variations in choice of incision location and length may affect ability to kneel; however, high-quality randomized trials are needed to corroborate our findings.
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Affiliation(s)
- Shaheer Nadeem
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
| | - Raman Mundi
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada.,Sunnybrook Holland Orthopaedic and Arthritic Centre, 43 Wellesley St E, Toronto, ON, M4Y 1H1, Canada
| | - Harman Chaudhry
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada.,Sunnybrook Holland Orthopaedic and Arthritic Centre, 43 Wellesley St E, Toronto, ON, M4Y 1H1, Canada
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8
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Zhang L, Li X, Rüwald JM, Welle K, Schildberg FA, Kabir K. Comparison of minimally invasive approaches and standard median parapatellar approach for total knee arthroplasty: A systematic review and network meta-analysis of randomized controlled trials. Technol Health Care 2021; 29:557-574. [DOI: 10.3233/thc-192078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Minimally invasive total knee arthroplasty (TKA) has been actively advertised by the orthopedic industry. The purpose of this network meta-analysis was to comprehensively compare the effectiveness of four minimally invasive surgery (MIS) approaches and the medial parapatellar (MPP) approach to improve the American Knee Society Score (KSS) in primary TKA. MATERIALS AND METHODS: Studies were comprehensively searched on PubMed, Embase, Cochrane Library (CENTRAL), Web of Science and Science Direct up to June 2018 with a major focus on the outcome of KSS. Risk of bias was assessed using the Cochrane risk of bias tool. Quality assessment was performed using the GRADE system. Both pair-wise and network meta-analyses are calculated to comprehensively compare the effectiveness of four MIS and TKA approaches. RESULTS: Eleven trials with 1025 knees undergoing TKA were included. Our analysis showed that both MPP and MIS approaches provided improvement in terms of short-term (four-eight weeks) total, objective and functional KSS. The network-meta analysis revealed that MIS approaches showed a trend towards superior KSS improvement over standard MPP approaches. However, statistical advantages were only observed in the mini-MPP group for functional KSS compared to the conventional MPP and quadriceps-sparing (QS) groups. CONCLUSIONS: Evidence shows that MIS TKA approaches are effective alternatives to MPP approaches. However, orthopedic surgeons should be cautiously optimistic about minimally invasive TKA in terms of KSS improvement.
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Affiliation(s)
- Li Zhang
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Xian Li
- Department of Orthopedic and Trauma Surgery, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing 100091, China
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Julian M. Rüwald
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Kristian Welle
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Frank A. Schildberg
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Koroush Kabir
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
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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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10
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Bouché PA, Corsia S, Nizard R, Resche-Rigon M. Comparative Efficacy of the Different Surgical Approaches in Total Knee Arthroplasty: A Systematic-Review and Network Meta-Analysis. J Arthroplasty 2021; 36:1187-1194.e1. [PMID: 33109416 DOI: 10.1016/j.arth.2020.09.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several surgical approaches including midvastus, subvastus, mini-parapatellar, quadriceps-sparring (QS) and parapatellar are currently used to perform total knee arthroplasty (TKA). Since none of published study exhibited a simultaneous comparison of all of them, a network meta-analysis has been conducted to compare the most widely used knee surgical approaches regarding the improvement of functional outcomes and the range of motion (ROM). METHODS Randomised controlled trials (RCTs) comparing TKA approaches were searched in electronic databases, major orthopedics journals, and oral communications, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform until May 1st, 2020. Two reviewers independently selected trials and extracted data. The primary outcomes were functional scores at 6 months post-surgeryevaluated by KSS and WOMAC, and the ROM. RESULTS Sixty RCTs involving 5042 patients with 5107 TKA were included. No significant differences between different approaches were found for the KSS assessment or the WOMAC at 6 months. The mean of ROM at 6 months post-surgery were higher in the subvastus group than in all the others surgical approaches. The difference of ROM with subvastus approach was 7.3° (95% CI -14.1 to -0.1) with the midvastus approach, 11.1° (95% CI -18.7 to -2.8) with mini-parapatellar, 8.9° (95% CI -14.2 to -3.1) with standard parapatellar, and 9.2° (95% CI -16.1 to -1.8) with QS. CONCLUSION No differences were found in functional outcomes over short or medium terms but subvastus seemed to increase the ROM at 6 months post-surgery. Until or unless future studies can demonstrate a long-term benefit, based on these results all studied surgical approaches to perform a TKA are equal. LEVEL OF EVIDENCE Network meta-analysis. Level 1.
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Affiliation(s)
- Pierre-Alban Bouché
- Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, APHP; Université Paris Diderot; ECSTRA Team, UMR U1153, INSERM, Paris, France; Service de chirurgie orthopédique et traumatologique, Hôpital Lariboisière, Paris, France
| | - Simon Corsia
- Service de chirurgie orthopédique et traumatologique, Hôpital Lariboisière, Paris, France
| | - Rémy Nizard
- Service de chirurgie orthopédique et traumatologique, Hôpital Lariboisière, Paris, France
| | - Matthieu Resche-Rigon
- Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, APHP; Université Paris Diderot; ECSTRA Team, UMR U1153, INSERM, Paris, France
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11
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Kim TK, Mittal A, Meshram P, Kim WH, Choi SM. Evidence-based surgical technique for medial unicompartmental knee arthroplasty. Knee Surg Relat Res 2021; 33:2. [PMID: 33413698 PMCID: PMC7792201 DOI: 10.1186/s43019-020-00084-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/26/2020] [Indexed: 01/04/2023] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a successful treatment modality in selected patients having advanced, single-compartment osteoarthritis of the knee. The bone and ligament preservation leading to shorter recovery periods, better functional outcomes, lower perioperative complication rates, and easier revision, if needed, are proposed as some of the advantages of UKA over total knee arthroplasty (TKA). Despite several advantages, UKA is reported to have higher failure rates as compared to TKA. The prosthesis failure of UKA is directly correlated to intraoperative technique-related factors like malpositioning of components and the inability to replicate the target-limb alignment as per preoperative planning. An evidence-based surgical technique for UKA may help surgeons to avoid the intraoperative technique-related errors. The purpose of this paper is to describe a stepwise surgical technique for the fixed-bearing medial UKA.
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Affiliation(s)
- Tae Kyun Kim
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
| | - Anurag Mittal
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Sang Min Choi
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
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12
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Mittal A, Meshram P, Kim WH, Kim TK. Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA. J Orthop Traumatol 2020; 21:15. [PMID: 32876817 PMCID: PMC7468046 DOI: 10.1186/s10195-020-00551-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a bone- and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as “Ten Enigmas of UKA.”
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Affiliation(s)
- Anurag Mittal
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Tae Kyun Kim
- TK Orthopedic Surgery, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
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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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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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Iamthanaporn K, Yuenyongviwat V, Laohawiriyakamol T, Tanutit P. Accuracy of medial-side cutting guide compared to anterior cutting guide in distal femoral osteotomy of total knee arthroplasty. J Clin Orthop Trauma 2019; 10:87-90. [PMID: 30705538 PMCID: PMC6349664 DOI: 10.1016/j.jcot.2017.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/19/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Minimally invasive surgery (MIS) in total knee arthroplasty has the benefits of less postoperative pain and a faster recovery time. An MIS instrument was designed to help surgeons perform this procedure under reduced visualization conditions. A medial cutting guide of the distal femur is used to cut the distal femoral bone without patella subluxation. This study aimed to compare the accuracy of the distal femoral bone cut between the medial and standard anterior cutting guides. MATERIALS AND METHODS Two orthopedic surgeons, who specialize in total knee arthroplasty and are familiar with both of these cutting guides, performed the procedures. Forty-eight synthetic saw bones were used, and five-degree valgus medial and anterior cutting guides were randomly assigned to the surgeons. After the osteotomies were performed, the synthetic saw bones were investigated via plain radiographs. Two independent radiologists measured the medial distal femoral angle (MDFA) and the posterior distal femoral angle (PDFA). RESULTS The MDFA in the medial cutting group was statistically significantly different from that of the anterior cutting group (94.18° ± 1.47° vs. 94.98° ± 1.14°, P = 0.041). However, the PDFA was not different between the two groups. Likewise, the number of outliers was not different between the groups when a ± 2° error was defined as an outlier (P = 0.609 for MDFA and P = 0.359 for PDFA). Moreover, a high degree of reliability was found in both MDFA and PDFA measurements (intraclass correlation coefficients = 0.813 and 0.824, respectively). CONCLUSIONS In this experimental study, the MIS medial cutting guide was less accurate than the standard cutting guide in the distal femoral cut.
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Affiliation(s)
- Khanin Iamthanaporn
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Corresponding author.
| | - Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Teeranan Laohawiriyakamol
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pramot Tanutit
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Yoo JH, Oh HC, Park SH, Kim JK, Kim SH. Does Obesity Affect Clinical and Radiological Outcomes in Minimally Invasive Total Knee Arthroplasty? Minimum 5-Year Follow-up of Minimally Invasive TKA in Obese Patients. Clin Orthop Surg 2018; 10:315-321. [PMID: 30174807 PMCID: PMC6107814 DOI: 10.4055/cios.2018.10.3.315] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/04/2018] [Indexed: 02/03/2023] Open
Abstract
Background The aim of this study was to evaluate the clinical and radiological outcomes of minimally invasive total knee arthroplasty (MIS-TKA) in obese patients. Methods We examined the records of 371 cases of MIS-TKA performed using the mini-midvastus approach from January 2006 to December 2006. According to body mass index (BMI), the cases were classified into group A (BMI < 25 kg/m2, 114 knees), group B (25 kg/m2 ≤ BMI < 30 kg/m2, 179 knees), and group C (BMI ≥ 30 kg/m2, 78 knees). Clinical outcomes were measured with the Hospital for Special Surgery Score and Knee Society Score. Radiological evaluation included measurements of knee alignment. Results MIS-TKA was performed on all patients. The skin incision size in group A, group B, and group C was 8.2 ± 0.8 cm, 8.3 ± 0.8 cm, and 8.5 ± 0.9 cm, respectively, and the operation time was 86.4 ± 10.4 minutes, 85.9 ± 11.3 minutes, and 89.0 ± 11.4 minutes, respectively, indicating no significant difference among the groups (p > 0.05). There was no difference in terms of the accuracy of the tibial implant alignment, with 97.6%, 95.2%, and 93.4% of each group showing 90° ± 3° varus angulation (p > 0.05). With respect to the accuracy of the femorotibial angle, 93.9%, 94.6%, and 90.2% of each group had 6° ± 3° valgus angulation, with group C demonstrating the lowest level of accuracy (p < 0.05). The preoperative range of motion and Knee Society Score of group C were less than those of groups A and B (p < 0.05), but there was no notable difference among groups at the postoperative 3-month and 1-year follow-ups (p > 0.05). Conclusions MIS-TKA in obese patients showed satisfactory clinical and radiological results without significant difference in surgical results compared to nonobese patients.
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Affiliation(s)
- Ju-Hyung Yoo
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun-Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jin-Kyu Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hee Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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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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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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Jenny JY. Minimally invasive unicompartmental knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:793-797. [PMID: 29280006 DOI: 10.1007/s00590-017-2107-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022]
Abstract
The exact indication for a unicompartmental knee arthroplasty (UKA) remains debated. Minimally invasive techniques have been developed to decrease the surgical trauma related to the prosthesis implantation, and this technique is well fitted to UKA. However, there are concerns about loss of accuracy with minimally invasive techniques. Furthermore, rapid recovery techniques have been developed in order to reduce the length of hospital stay. Again, UKA is well fitted to these new developments of postoperative care. We combine routinely a minimal invasive operative technique with navigation assistance to ensure proper positioning of the implants as well as an optimal ligamentous balance. Instruments have been adapted for use with a typical 6-cm skin incision with little change from the conventional navigated operating technique. A multimodal pain treatment is implemented immediately after the implantation, with special attention to a routine saphenous nerve blockade. Patients are instructed to stand up on the day of surgery with full weight bearing and to mobilize the knee joint without restriction. They may be discharged at least on the day following surgery, and the most favorable patients may be operated in our day-case surgery unit. These conclusions should be confirmed on a larger scale.
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Affiliation(s)
- Jean-Yves Jenny
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France.
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20
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Ishii Y, Noguchi H, Sato J, Ishii H, Yamamoto T, Sakurai T, Toyabe SI. Clinical relevance of active straight leg raising, standing up, and walking after total knee arthroplasty in a cross-sectional study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:947-953. [DOI: 10.1007/s00590-017-2100-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 11/24/2022]
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21
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Hong CM. Minimally Invasive Joint Replacement Surgery: Where Are We Now? J Orthop Case Rep 2017; 7:3-4. [PMID: 29051868 PMCID: PMC5635181 DOI: 10.13107/jocr.2250-0685.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Cheung Man Hong
- Department of Orthopaedics and Traumatology, Division of Joint Replacement Surgery, The University of Hong Kong, Hong Kong
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22
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Rutherford RW, Jennings JM, Dennis DA. Enhancing Recovery After Total Knee Arthroplasty. Orthop Clin North Am 2017; 48:391-400. [PMID: 28870300 DOI: 10.1016/j.ocl.2017.05.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There have been multiple successful efforts to improve and shorten the recovery period after elective total joint arthroplasty. The development of rapid recovery protocols through a multidisciplinary approach has occurred in recent years to improve patient satisfaction as well as outcomes. Bundled care payment programs and the practice of outpatient total joint arthroplasty have provided additional pressure and incentives for surgeons to provide high-quality care with low cost and complications. In this review, the evidence for modern practices are reviewed regarding patient selection and education, anesthetic techniques, perioperative pain management, intraoperative factors, blood management, and postoperative rehabilitation.
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Affiliation(s)
- Richard W Rutherford
- Colorado Joint Replacement, Porter Adventist Hospital, 2535 S. Downing Street, Denver, CO 80210, USA.
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, 2535 S. Downing Street, Denver, CO 80210, USA
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, 2535 S. Downing Street, Denver, CO 80210, USA; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
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23
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Yuan FZ, Wang SJ, Zhou ZX, Yu JK, Jiang D. Malalignment and malposition of quadriceps-sparing approach in primary total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2017; 12:129. [PMID: 28874195 PMCID: PMC5585942 DOI: 10.1186/s13018-017-0627-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/05/2017] [Indexed: 11/14/2022] Open
Abstract
Background Quadriceps-sparing (QS) approach is considered to be the most minimally invasive surgery for total knee arthroplasty (TKA). We perform this meta-analysis to evaluate whether malalignment and malposition are more biased towards the QS approach compared to the traditional medial parapatellar (MP) approach, which is still controversial. Methods According to the PRISMA guidelines, a comprehensive search was conducted in the databases of PubMed, the Cochrane library, and Embase. Relevant measures were extracted independently by two investigators. Results Five randomized controlled trials (RCTs) and eight retrospective studies including a total of 1261 cases were identified. The QS approach was associated with more outliers of hip-knee-ankle (HKA) angle (p = 0.03), coronal tibial component angle (p = 0.03), and femoral notch (p = 0.05). However, the differences of the outlier of the coronal femoral component angle between the two groups were not statistically significant. Conclusions This meta-analysis indicates that the QS approach is related to the high risk of malalignment and malposition. However, different studies reported different indicators resulting in small samples for analyzing the radiological outcomes. In addition, both of the relatively long learning curve and the present instruments might increase the risk of malalignment and malposition of the QS approach, which needs further study and improvement.
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Affiliation(s)
- Fu-Zhen Yuan
- Institute of Sports Medicine, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China
| | - Shao-Jie Wang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China
| | - Zhu-Xing Zhou
- Institute of Sports Medicine, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China
| | - Jia-Kuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China.
| | - Dong Jiang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49 North, Garden Road, Haidian, Beijing, 100191, China.
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Hasegawa M, Miyazaki S, Yamaguchi T, Wakabayashi H, Sudo A. Comparison of Midterm Outcomes of Minimally Invasive Computer-Assisted vs Minimally Invasive Jig-Based Total Knee Arthroplasty. J Arthroplasty 2017; 32:43-46. [PMID: 27503697 DOI: 10.1016/j.arth.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) has perceived advantages in the early postoperative stage for total knee arthroplasty (TKA). It is not clear whether the improved radiographic alignment achieved by computer-assisted navigation surgery (CAS) improves midterm clinical outcomes. The aim of this study was to compare patient outcomes of MIS TKA performed with and without CAS after a minimum follow-up of 7 years. METHODS Between 2007 and 2009, 50 patients underwent CAS and MIS TKA, and 50 patients underwent jig-based MIS TKA in this prospective study. Ninety-six patients were evaluated after a mean follow-up of 7.7 years, and clinical and radiological evaluations were performed. RESULTS Midterm results demonstrated that the Knee Society knee score, function score, and range of motion were comparable in the 2 groups. The percentage of patients with the mechanical axis within ±3° of neutral was significantly higher in the CAS group than in the jig-based group (94% vs 79%, respectively; P = .038). No knees had loosening after TKA. However, 1 patient in the CAS group demonstrated late infection 4 years postoperatively. CONCLUSION CAS did not improve midterm outcomes after MIS TKA compared with jig-based surgery, although CAS reduced outliers in coronal alignment.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shinichi Miyazaki
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Toshio Yamaguchi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Confalonieri N, Biazzo A, Cerveri P, Pullen C, Manzotti A. Navigated "small implants" in knee reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:3507-3516. [PMID: 27631647 DOI: 10.1007/s00167-016-4324-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/07/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE At the beginning of this century, unprecedented interest in the concept of using less invasive approaches for the treatment of knee degenerative diseases was ignited. Initial interest in this approach was about navigated and non-navigated knee reconstruction using small implants and conventional total knee arthroplasty. METHODS To this end, a review of the published literature relating to less invasive compartmental arthroplasty of the knee using computer-based alignment techniques and on soft tissue-dedicated small implants is presented. The authors present and compare their personal results using these techniques with those reported in the current literature. These involved the use of a shorter incision and an emphasis sparing. However, nowadays most surgeons look at compartmental knee resurfacing with the use of small implants as the new customized approach for younger and higher-demand patients. The aim of this paper is to stimulate further debate. RESULTS Since the beginning of 2000, computer-assisted surgery has been applied to total knee arthroplasty (TKA) and later to compartmental knee arthroplasty. Recent studies in the literature have reported better implant survivorship for younger patients using navigation in TKA at longer-term follow-up. Only one published report was identified showing superior clinical outcomes at short-term follow-up using computer-assisted technology compared with conventional alignment techniques in small implant surgery. No studies were found in the literature that demonstrated similar clinical advantages with navigated small implants at long-term follow-up. Two published meta-analyses were identified reporting better implant and limb alignment and no increase in complications using a navigated unicompartmental knee arthroplasty. However, neither meta-analysis showed superior clinical outcomes or survivorship with the navigated techniques. CONCLUSION In conclusion, we can assert that replacing just the damaged compartment and preserving the normal biomechanics will require not only new implant designs but also new technologies allowing the surgeon to make extremely precise adjustments to implant alignment and providing continuous feedback during surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Norberto Confalonieri
- 1st Orthopaedic and Trauma Department, CTO Hospital, ASST G. Pini-CTO, Milan, Italy.
| | - Alessio Biazzo
- 1st Orthopaedic and Trauma Department, CTO Hospital, ASST G. Pini-CTO, Milan, Italy
| | - Pietro Cerveri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20100, Milan, Italy
| | - Chris Pullen
- Orthopaedic Department, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alfonso Manzotti
- Orthopaedic and Trauma Department, "Luigi Sacco" Hospital, ASST FBF-Sacco, Milan, Italy
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Shin YS, Kim HJ, Ko YR, Yoon JR. Minimally invasive navigation-assisted versus conventional total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24:3425-3432. [PMID: 26860101 DOI: 10.1007/s00167-016-4016-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE It is unclear whether the minimally invasive navigation-assisted (MINA) or conventional (CONv) approach for primary total knee arthroplasty (TKA) leads to better clinical and radiographic outcomes. This meta-analysis compared the clinical and radiographic outcomes of the MINA and CONv approaches after primary TKA. It was hypothesized that there was no difference in clinical and radiographic outcomes between the two surgical approaches for primary TKA. METHODS This meta-analysis reviewed all studies that compared surgical time, incision length, flexion range of motion (ROM), Knee Society Score ( KSS), coronal mechanical axis (CMA), and coronal femoral component angle (CFCA) with various measurement tools, from direct interview to plain radiography, between the MINA and CONv approaches. RESULTS Five studies met the inclusion/exclusion criteria for the meta-analysis. The findings of this study suggest that surgical time (95 % CI -18.51 to 39.09; n.s.), KSS (95 % CI -8.55 to 30.84; n.s.), CMA (95 % CI -1.01 to 0.54; n.s.), and CFCA (95 % CI -0.91 to 2.97; n.s.) were similar between the two surgical approaches, whereas incision length (95 % CI -5.18 to -3.69; P < 0.001) was significantly shorter in the MINA approach and flexion ROM (95 % CI 14.26-19.01; P < 0.001) was significantly greater in the MINA approach. CONCLUSIONS There were no significant differences in clinical and radiographic outcomes, including surgical time, KSS, CMA, and CFCA, in patients who underwent MINA and CONv approach for primary TKA, but the MINA approach resulted in a slightly shorter incision length and increased flexion ROM than the CONv approach. Therefore, if particular attention has to be paid to patient's selection with appropriate counselling and surgeon's experience, MINA approach can provide early clinical benefit when compared with CONv approach. Besides, orthopaedic surgeons need to master the MINA and CONv approaches because both approaches have similar clinical and radiographic outcomes. LEVEL OF EVIDENCE Therapeutic study, Level II.
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Affiliation(s)
- Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, South Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Young-Rok Ko
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, South Korea
| | - Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 61 Jinhwangdoro-gil, Gangdong-Gu, Seoul, 134-791, South Korea.
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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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Alcelik IA, Blomfield MI, Diana G, Gibbon AJ, Carrington N, Burr S. A Comparison of Short-Term Outcomes of Minimally Invasive Computer-Assisted vs Minimally Invasive Conventional Instrumentation for Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2016; 31:410-8. [PMID: 26507525 DOI: 10.1016/j.arth.2015.09.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/24/2015] [Accepted: 09/09/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Median parapatellar approach is the most used for total knee arthroplasty (TKA). With the advent of enhanced recovery and shorter length of hospital stay, there is an increasing pressure on surgeons to perform surgery through smaller incisions. Minimally invasive (MIS) TKA allows earlier functional recovery; it is not clear if this is associated with more complications. It is also unclear if computer-assisted minimally invasive (MIS CA) TKA has any affect on improving patient outcomes. We performed a systematic review and meta-analysis comparing MIS CA vs MIS TKA. METHODS We performed an extensive literature search including both randomized controlled studies and prospective cohort studies. All data reported on component alignment, surgical time, complications, knee flexion, and postoperative functional knee scores were included for analysis. RESULTS Ten studies were suitable for inclusion resulting in 490 patients with MIS CA and 503 MIS patients. There was no significant difference in the outliers on complications, knee flexion, and postoperative functional scores. Coronal plane tibial component showed statistically significant number of outliers in the MIS group demonstrating superior component positioning in the MIS CA group. Operative time was significantly longer in the MIS CA group with a mean increase of 32 minutes. CONCLUSIONS Computer-assisted minimally invasive TKA is superior than the standard MIS TKA in terms of component positioning; however, it is unclear if this will have any long-term clinical implications. The increased operative time, although clinically relevant, does not appear to be associated with an increase in complications.
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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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Abstract
BACKGROUND An ideal approach for valgus knees must provide adequate exposure with minimal complications due to approach per se. Median parapatellar approach is most commonly used approach in TKA including valgus knees. A medial subvastus approach is seldom used for valgus knees and has definite advantages of maintaining extensor mechanism integrity and minimal effect on patellar tracking. The present study was conducted to evaluate outcomes of total knee arthroplasty (TKA) and efficacy of subvastus approach in valgus knees in terms of early functional recovery, limb alignment and complications. MATERIALS AND METHODS We retrospectively reviewed 112 knees with valgus deformity between January 2006 and December 2011. All patients were assessed postoperatively for pain using Visual Analog Scale (VAS) and quadriceps recovery in form of time to active straight leg raising (SLR) and staircase competency and clinical outcomes using American Knee Society (AKS) score and radiographic evaluation with average followup of 40 months (range 24-84 months). RESULTS The mean VAS on postoperative day (POD) 1 and POD2 at rest was 2.73 and 2.39, respectively and after mobilization was 3.28 and 3.08, respectively (P < 0.001). The quadriceps recovery was very early and 92 (86.7%) patients were able to do active SLR by POD1 with mean time of 21.98 h while reciprocal gait and staircase competency was possible at 43.05 h. The AKS and function score showed significant improvement from preoperative mean score of 39 and 36 to 91 and 79 (P < 0.001), respectively, and the mean range of motion increased from 102° preoperatively to 119° at recent followup (P < 0.001). The mean tibiofemoral valgus was corrected from preoperative 16° (range 10°-35°) to 5° (range 3°-9°) valgus (P < 0.001). CONCLUSIONS Mini-subvastus quadriceps approach provides adequate exposure and excellent early recovery for TKA in valgus knees, without increase in incidence of complications.
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Affiliation(s)
- Nilen Amulak Shah
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India,Address for correspondence: Dr. Nilen Amulak Shah, Flat No. 2, Building No. 2, India House, Kemps Corner, Mumbai - 400 026, Maharashtra, India. E-mail:
| | - Nimesh Prakash Jain
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India,Joint Reconstruction Center, Seoul National University Bundang Hospital, Bundang-Gu, Seongnam-Si, Korea
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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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Lenich A, Siebenlist S, Imhoff AB. [Complication management in implant dislocation]. Chirurg 2015; 86:943-8. [PMID: 26231435 DOI: 10.1007/s00104-015-0057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are many reasons for an implant malposition. Besides knowlege about prevention of implant dislocation, accurate planning of the osteosynthesis, extensive knowlege of the anatomy of the region in question, using all necessary diagnostic tools, choosing the correct approach and the best implant for fracture fixation are also important factors. Nevertheless, implant complications can still be found and if an intraoperative or postoperative implant dislocation occurs a suitable management is necessary. This article describes the different osteosynthesis implants and possible malpositions and dislocations. Tips and tricks are described in order to facilitate the correct indications for the further procedure.
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Affiliation(s)
- A Lenich
- Abt. für Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675, München, Deutschland.
| | - S Siebenlist
- Klinik für Unfallchirurgie, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - A B Imhoff
- Abt. für Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675, München, Deutschland
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Liu HC, Kuo FC, Huang CC, Wang JW. Mini-midvastus total knee arthroplasty in patients with severe varus deformity. Orthopedics 2015; 38:e112-7. [PMID: 25665115 DOI: 10.3928/01477447-20150204-58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 04/28/2014] [Indexed: 02/03/2023]
Abstract
Patients with severe varus deformity of the knee (≥15° varus) usually are not considered good candidates for minimally invasive total knee arthroplasty (TKA). The goal of this study was to retrospectively investigate outcomes in patients with severe varus deformity after minimally invasive TKA. A study group of 52 patients with a tibiofemoral mechanical axis of 195° or greater was compared with a matched control group of 55 patients with a tibiofemoral mechanical axis of less than 195°. Clinical and radiographic evaluations according to the American Knee Society rating system were obtained preoperatively and postoperatively, and postoperative patient satisfaction in the 2 groups was compared. All patients were followed at a mean of 3 years (range, 2-5 years). Preoperatively, clinical knee and function scores and range of motion were inferior in the study group compared with the control group (P<.001). However, at the latest follow-up, both groups of patients were satisfied with the clinical results, and no significant differences were found in the knee and function scores (P>.05). Radiographic evaluation showed no differences in the mechanical axis, femoral component valgus angle, and tibial component valgus angle, and all outliers of the radiographic parameters between the 2 groups postoperatively (P >.05). The study results showed that mini-midvastus TKA did not result in more inaccurate implant positioning in patients with severe varus deformity of the knee. The clinical outcome in the group with severe varus was comparable to that in the group with less severe varus
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Yoo JH, Park BK, Han CD, Oh HC, Park SH. Minimum 5-year Follow-up Results of Minimally Invasive Total Knee Arthroplasty Using Mini-Keel Modular Tibial Implant. Knee Surg Relat Res 2014; 26:149-54. [PMID: 25229044 PMCID: PMC4163572 DOI: 10.5792/ksrr.2014.26.3.149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 06/03/2014] [Accepted: 06/16/2014] [Indexed: 11/11/2022] Open
Abstract
Purpose To evaluate the minimum 5-year mid-term clinical and radiological results of minimally invasive surgery total knee arthroplasty (MIS-TKA) using a mini-keel modular tibia component. Materials and Methods We retrospectively evaluated 254 patients (361 cases) who underwent MIS-TKA between 2005 and 2006. The latest clinical and radiological assessments were done in 168 cases that had been followed on an outpatient basis for more than 5 postoperative years. Clinical results were assessed using the Hospital for Special Surgery (HSS) score and Knee Society score. Radiological evaluation included measurements of knee alignment. Results The average postoperative knee range of motion and HSS score were 134.3°±12.4° and 92.7°±7.0°, respectively. The average postoperative femorotibial angle and tibial component alignment angle were 5.2°±1.7° valgus and 90.2°±1.6°, respectively. The average tibial component posterior inclination was 4.8°±2.1°. The percentage of cases with tibial component alignment angle of 90°±3° was 96.1%, and that with the femorotibial angle of 6°±3° valgus was 94.0%. Radiolucent lines were observed in 20 cases (12.0%): around the femur, tibia, and patella in 14 cases, 10 cases, and 1 case, respectively. However, they were less than 2 mm and non-progressive in all cases. The survival rate was 99.4% and there was no implant-related revision. Conclusions MIS-TKA using a mini-keel modular tibial plate showed satisfactory results, a high survival rate, and excellent clinical and radiological results in the mid-term follow-up.
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Affiliation(s)
- Ju-Hyung Yoo
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Byoung-Kyu Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Dong Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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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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Assessment of accuracy of robotically assisted unicompartmental arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22:1918-25. [PMID: 24744171 DOI: 10.1007/s00167-014-2969-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/26/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to analyse the accuracy of component placement during unicompartmental knee arthroplasty (UKA) using a robotic-assisted system. METHODS Two hundred and six patients (232 knees) who underwent medial robotic-assisted UKA were retrospectively studied. Femoral and tibial sagittal and coronal alignments were measured in the post-operative radiographs and were compared with the equivalent measurements collected during the intra-operative period by the robotic system. Mismatch between pre-planning and post-operative radiography was assessed against accuracy of the prosthesis insertion. RESULTS Robotic-assisted surgery for medial UKA resulted in an average difference of 2.2° ± 1.7° to 3.6° ± 3.3° depending on the component and radiographic view between the intra-operatively planned and post-operative measurements. Mismatch between pre-planning and post-operative radiography (inaccuracy) was related to improper cementing technique of the prosthesis in all measurements (except for tibial sagittal axis) rather than wrong bony cuts performed by the robotic arm. CONCLUSION Robotic-assisted medial UKA results in accurate prosthesis position. Inaccuracy may be attributed to suboptimal cementing technique.
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Computer-navigated minimally invasive total knee arthroplasty for patients with retained implants in the femur. Kaohsiung J Med Sci 2014; 30:415-21. [PMID: 25002380 DOI: 10.1016/j.kjms.2014.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 01/29/2014] [Indexed: 11/23/2022] Open
Abstract
Total knee arthroplasty (TKA) in patients with knee arthritis and retained implants in the ipsilateral femur is a challenge for knee surgeons. Use of a conventional intramedullary femoral cutting guide is not practical because of the obstruction of the medullary canal by implants. Previous studies have shown that computer-assisted surgery (CAS) can help restore alignment in conventional TKA for patients with knee arthritis with retained femoral implants or extra-articular deformity, without the need for implant removal or osteotomy. However, little has been published regarding outcomes with the use of navigation in minimally invasive surgery (MIS)-TKA for patients with this complex knee arthritis. MIS has been proven to provide less postoperative pain and faster recovery than conventional TKA, but MIS-TKA in patients with retained femoral implants poses a greater risk in limb malalignment. The purpose of this study is to report the outcome of CAS-MIS-TKA in patients with knee arthritis and retained femoral implants. Between April 2006 and March 2008, eight patients with knee arthritis and retained femoral implants who underwent the CAS-MIS-TKA were retrospectively reviewed. Three of the eight patients had extra-articular deformity, including two femur bones and one tibia bone, in the preoperative examination. The anteroposterior, lateral, and long-leg weight-bearing radiographs carried out at 3-month follow-up was used to determine the mechanical axis of lower limb and the position of components. The mean preoperative femorotibial angle in patients without extra-articular deformity was 3.8° of varus and was corrected to 4.6° of valgus. With the use of navigation in MIS-TKA, the two patients in this study with extra-articular femoral deformity also obtained an ideal postoperative mechanical axis within 2° of normal alignment. Overall, there was a good restoration of postoperative mechanical alignment in all cases, with a mean angle of 0.4° of varus. No limb malalignment or component malposition was found. In clinical assessments, there were also significant improvements in knee specific scores, functional scores, and motion arc. The results of this study suggest that navigation can help achieve accurate alignment and proper prosthesis positioning in MIS-TKA for patients with retained femoral implants and for whom intramedullary rod guidance is impractical.
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Navigated total knee arthroplasty: is it error-free? Knee Surg Sports Traumatol Arthrosc 2014; 22:643-9. [PMID: 24061715 DOI: 10.1007/s00167-013-2641-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to determine whether errors do occur in navigated total knee arthroplasty (TKAs) and to study whether errors in bone resection or implantation contribute to these errors. METHODS A series of 20 TKAs was studied using computer navigation. The coronal and sagittal alignments of the femoral and tibial cutting guides, the coronal and sagittal alignments of the final tibial implant and the coronal alignment of the final femoral implant were compared with that of the respective bone resections. To determine the post-implantation mechanical alignment of the limb, the coronal alignment of the femoral and tibial implants was combined. RESULTS The median deviation between the femoral cutting guide and bone resection was 0° (range -0.5° to +0.5°) in the coronal plane and 1.0° (range -2.0° to +1.0°) in the sagittal plane. The median deviation between the tibial cutting guide and bone resection was 0.5° (range -1.0° to +1.5°) in the coronal plane and 1.0° (range -1.0° to +3.5°) in the sagittal plane. The median deviation between the femoral bone resection and the final implant was 0.25° (range -2.0° to 3.0°) in the coronal plane. The median deviation between the tibial bone resection and the final implant was 0.75° (range -3.0° to +1.5°) in the coronal plane and 1.75° (range -4.0° to +2.0°) in the sagittal plane. The median post-implantation mechanical alignment of the limb was 0.25° (range -3.0° to +2.0°). CONCLUSIONS When navigation is used only to guide the positioning of the cutting jig, errors may arise in the manual, non-navigated steps of the procedure. Our study showed increased cutting errors in the sagittal plane for both the femur and the tibia, and following implantation, the greatest error was seen in the sagittal alignment of the tibial component. Computer navigation should be used not only to guide the positioning of the cutting jig, but also to check the bone resection and implant position during TKA. LEVEL OF EVIDENCE IV.
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Heekin RD, Fokin AA. Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium. J Arthroplasty 2014; 29:339-42. [PMID: 23790343 DOI: 10.1016/j.arth.2013.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/25/2013] [Accepted: 05/13/2013] [Indexed: 02/01/2023] Open
Abstract
Comparisons between mini-midvastus (mMV) and mini-medial parapatellar approach (mMPP) for total knee arthroplasty (TKA) have reported variable results. We compared two approaches with minimum two year follow up. Forty consecutive patients who underwent staged bilateral TKA were prospectively randomized for mMPP approach in one knee and mMV approach in the other. Clinical parameters (muscle strength, pain, ROM, Knee Society Score) and surgic.l parameters (duration of surgery, blood loss, lateral releases) were assessed at 2, 6, 12 weeks and 6, 12, 24 months postoperatively. Clinical outcomes revealed inconsistent pattern of differences at various intervals. Surgical outcomes were not different. There were no major differences in outcomes between the two approaches. We recommend someone use surgical approach with which they are most familiar.
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Minimally invasive total knee arthroplasty; a pragmatic randomised controlled trial reporting outcomes up to 2 year follow up. Knee 2014; 21:189-93. [PMID: 23972565 DOI: 10.1016/j.knee.2013.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 06/25/2013] [Accepted: 07/25/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND We present a prospective, randomised, multi-surgeon, controlled trial comparing minimally invasive (MIS) and standard approach total knee arthroplasty (TKA). METHODS Participants underwent unilateral TKA. Patients were randomised to Bristol, quadriceps sparing MIS or standard medial parapatellar approaches. Length of stay with secondary outcome measures including knee range of movement, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) and American Knee Society Score (KSS) up to 2 years. Radiographic and post operative assessment was blinded. RESULTS 86 patients (92 knees) participated in the study. Mean operative time between MIS and control groups was 95.5 (95% CI 90.0-101.0) and 94.8 (95% CI 88.2-101.4) minutes respectively. Mean readiness for discharge was shorter in the MIS group 4.5±1.5 (95% CI, 4.1-4.9) days versus 5.9±2.7 (95% CI, 5.1-6.7) days amongst controls (p=0.004). Patients in the MIS group had fewer complications (p=0.003). One patient developed a deep vein thrombosis (DVT) and one required revision surgery, both in the control group. 83 patients completed follow up to 2 years (40 MIS, 43 controls). Range of movement and other outcome measures improved up to 1 year post-operatively with no statistically significant differences between MIS and controls. We found no evidence of radiographic loosening in either group at the 2 year follow up. CONCLUSIONS MIS offers reduced length of stay and fewer complications for patients following TKR without evidence of component mal-alignment. Our findings of fewer systemic complications in MIS TKR patients warrant further future study. LEVEL OF EVIDENCE Level 1.
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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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Thienpont E. Faster recovery after minimally invasive surgery in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21:2412-7. [PMID: 22466015 DOI: 10.1007/s00167-012-1978-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 03/15/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the study was to identify whether less soft tissue and muscle damage during surgery will allow faster recovery after total knee arthroplasty in comparison with the conventional technique. A limited medial parapatellar approach without tibial medial collateral ligament (MCL) desinsertion was compared with the conventional parapatellar approach. METHODS Three hundred patients were randomized either into the minimally invasive group (MIS group) or into the conventional group (CON group). The evaluation was based on the Knee Society Score, range of motion, blood loss, period of hospitalization and postoperative hemoglobin level. RESULTS The MIS group showed faster recovery with immediate postoperative full weight-bearing and shorter length of stay (5 vs 10 days). Comparable Knee Society Scores (87.5 vs 88), function scores (90) and alignment (5.5° vs 5.2°) between the CON and MIS group were observed at a follow-up of 24 months. No increase in operative times (52 vs 51 min tourniquet time) or no complications were observed. Reduced blood loss was observed in the MIS group (590 vs 989 ml). CONCLUSION The MCL sparing limited medial parapatellar approach allows good surgical exposure, easy extension proximally if necessary, contained closure after surgery with less bleeding, faster recovery, full weight-bearing without aid and most importantly no radiological malalignment. LEVEL OF EVIDENCE Therapeutic study, Level II.
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Affiliation(s)
- Emmanuel Thienpont
- Department of Orthopaedic Surgery, Saint Luc University Hospital, Avenue Hippocrate 10, 1200, Brussels, Belgium,
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Faster quadriceps recovery with the far medial subvastus approach in minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21:2370-4. [PMID: 23007414 DOI: 10.1007/s00167-012-2215-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To identify whether less proximal muscle damage during minimally invasive surgery will allow faster recovery after total knee arthroplasty in comparison with a quadriceps incision approach. A limited medial parapatellar approach without tibial medial collateral ligament (MCL) release was compared to a subvastus approach without tibial medial collateral ligament release (far medial subvastus). METHODS One hundred and eighty patients were studied. In the mini-parapatellar group, ninety patients and in the far medial subvastus group, the remaining ninety patients were included. The evaluation was based on the Knee Society Score, VAS, morphine consumption, range of motion, time to straight leg raising, walking without aid, stairs and period of hospitalization. Alignment on full leg radiographs and component position on plain films were measured. RESULTS The far medial subvastus group showed faster recovery with earlier straight leg raising (1.7 ± 0.5 vs. 2.7 ± 0.4 days), postoperative weight bearing without aid (1.7 ± 0.6 vs. 2 ± 0.8 days) and stair negotiation (3 ± 0.4 vs. 4 ± 0.3 days) resulting in shorter length of stay (4 ± 0.5 vs. 5 ± 1.2 days). Comparable Knee Society Scores (88.5 ± 6.8 vs. 90 ± 10), Function Scores (90 ± 10) and alignment (5.4° ± 2.1° vs. 5.0° ± 2.4°) between the medial parapatellar and far medial subvastus group were observed at a follow-up of 24 months. An increase in operative time for the far medial subvastus was observed (55 ± 10.6 min vs. 67 ± 12 min tourniquet time) but without complications. CONCLUSION The MCL sparing far medial subvastus approach allows good surgical exposure, faster straight leg raising, full weight bearing without aid and shorter length of stay with most importantly no radiological malalignment. LEVEL OF EVIDENCE Therapeutic study, Level II.
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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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Stevens-Lapsley JE, Bade MJ, Shulman BC, Kohrt WM, Murature TR, Dayton MR. Minimally invasive total knee arthroplasty: surgical implications for recovery. J Knee Surg 2013; 26:195-201. [PMID: 23288738 PMCID: PMC4162390 DOI: 10.1055/s-0032-1327449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite growing interest in minimally invasive surgery (MIS) techniques for total knee arthroplasty (TKA), few randomized controlled trials have compared MIS and conventional TKA using a combination of functional performance, knee pain, knee range of motion (ROM), and surgical and radiographic outcomes. METHODS A prospective, randomized investigation comparing early outcomes of TKA using conventional or MIS approaches (n = 44). Patients were assessed preoperatively, 48 hours, 4 and 12 weeks postoperatively by blinded evaluators. Outcome measures included timed-up-and-go, 100-ft walk, knee pain, passive knee ROM, Knee Society Score, blood loss, tourniquet time, hospital length of stay, surgical complications, and radiographic outcomes. RESULTS No significant differences in functional performance, knee pain, knee ROM, surgical, or radiographic outcomes were observed between groups at 48 hours, 4 or 12 weeks postoperatively. CONCLUSION While surgical and radiographic outcomes were not compromised with MIS surgery, there were also no improvements in pain, ROM, or functional performance with MIS TKA.
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Affiliation(s)
| | - Michael J. Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado
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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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A prospective randomised study of minimally invasive midvastus total knee arthroplasty compared with standard total knee arthroplasty. Knee 2012; 19:866-71. [PMID: 22608852 DOI: 10.1016/j.knee.2012.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Proposed advantages of minimally invasive surgery include shorter hospital stay, less blood loss, and a greater range of motion but potential concerns are raised about both prolonged learning curves and a compromise in exposure leading to implant malposition. PATIENTS AND METHODS This powered study evaluates the outcomes of 80 patients randomised to have mini-midvastus (MMV) approach or standard medial parapatellar (MPP) approach. Rehabilitation protocols and discharge criteria were standardised. Patients were discharged home directly, capable of safe independent care. Validated outcome measures were recorded post-operatively at intervals up to 1 year. Independent, blinded review of post-operative x-rays was obtained. RESULTS Length of stay was similar in the MMV and MPP groups (median 3.73 days vs. 3.75 days). No statistically significant differences were detected in either the demographic data or any intra-operative variable apart from blood loss and incision length. No statistically significant difference in clinical outcome measures (Oxford/Knee Society Scores) or radiographic analysis was observed. CONCLUSION The MMV approach does not appear to confer any clinically significant benefit apart from a smaller surgical scar, compared to the MPP surgical technique. Level of evidence I: randomised control trial. R.E.C. 040301.
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Hasegawa M, Yoshida K, Wakabayashi H, Sudo A. Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system. INTERNATIONAL ORTHOPAEDICS 2012; 37:27-30. [PMID: 23104676 DOI: 10.1007/s00264-012-1688-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/12/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of bone cutting and implantation in minimally invasive total knee arthroplasty with image-free navigation. METHODS The alignment of the tibial and femoral bone resection was measured in 40 knees during surgery. The alignment measurement was repeated after cementing the tibial and femoral components. We evaluated the cutting error and the implanting error. RESULTS The mean tibial cutting errors were 0.5 and 0.7° in the frontal and sagittal planes, respectively. The mean femoral cutting errors were 0.5 and 0.9° in the frontal and sagittal planes, respectively. The mean tibial implanting errors were 1.0 and 0.9° in the frontal and sagittal planes, respectively. The mean femoral implanting error was 0.7° in the frontal plane. CONCLUSIONS Computer-assisted navigation was useful in checking the alignment of both bone cut and cementation.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan.
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Kim SM, Park YS, Ha CW, Lim SJ, Moon YW. Robot-assisted implantation improves the precision of component position in minimally invasive TKA. Orthopedics 2012; 35:e1334-9. [PMID: 22955398 DOI: 10.3928/01477447-20120822-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Minimally invasive and robot-assisted procedures have potential advantages when used for total knee arthroplasty (TKA). The purpose of this cadaveric study was to examine whether robot-assisted minimally invasive procedures improve TKA alignment after modifying the robotic techniques and instruments. Total knee arthroplasties were performed on 10 pairs of fresh cadaveric femora. Ten knees were replaced using the robot-assisted minimally invasive technique and 10 using the conventional minimally invasive technique. After prosthesis implantation, limb and prosthesis alignments were investigated by measuring mechanical axis deviation, femoral and tibial sagittal and coronal inclination, and femoral rotational alignment with 3-dimensional computed tomography scans. Postoperative alignment accuracy of the implanted prostheses was better in the robot-assisted minimally invasive TKA group than in the conventional minimally invasive TKA group as judged by the rotational alignment of the femoral component (0.7°±″.3° vs 3.6°±2.2°, respectively) and the tibial component sagittal angle (7.8°±1.1° vs 5.5°±3.6°, respectively). One sagittal inclination outlier for the tibial side existed in the robotic minimally invasive TKA group, and 2 outliers for the mechanical axis, 2 for the tibial side sagittal inclination, and 2 for the femoral rotational alignment existed in the conventional minimally invasive TKA group. Higher implanted prostheses accuracy and fewer outliers in postoperative radiographic alignments can be attained with robot-assisted TKA. Minimally invasive TKA in combination with an improved robot-assisted technique is an alternative option to compensate for the shortcomings of conventional minimally invasive TKA.
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Affiliation(s)
- Sang-Min Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Changwon, Korea
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