Abstract
PurposeMinimally invasive surgery (MIS) for total knee arthroplasty (TKA) is often marketed as being able to speed up healing times over standard invasive surgery (SIS) through the medial parapatellar approach. The advantages of these minimally invasive approaches, however, are not yet definitively established. A meta-analysis of studies comparing peri-operative and post-operative differences and long-term complications of MIS versus SIS for TKA was conducted.MethodsThis meta-analysis was conducted following the PRISMA guidelines. The Pubmed, Google Scholar, Scopus, and Embase databases were accessed in September 2020. All clinical trials comparing minimally-invasive versus standard approaches for TKA were considered. Only studies reporting quantitative data under the outcomes of interest were included. Methodological quality assessment was performed using the PEDro appraisal score.ResultsThis meta-analysis covers a total of 38 studies (3296 procedures), with a mean 21.3 ± 24.3 months of follow-up. The MIS group had shorter hospitalization times, lower values of total estimated blood loss, quicker times of straight-leg raise, greater values for range of motion, higher scores on the Knee Society Clinical Rating System (KSS) and its related Function Subscale (KSFS). Pain scores, anterior knee pain and revision rate were similar between MIS and SIS. SIS allowed a quicker surgical duration.ConclusionThe present meta-analysis encourages the use of minimally invasive techniques for total knee arthroplasty. However, MIS TKA is technically demanding and requires a long learning curve.Level of evidenceIII, meta-analysis of clinical trials.
Highlights
The most common exposure for total knee arthroplasty (TKA) is the medial parapatellar arthrotomy (MPP) using standard incision surgery (SIS) [22]
Despite the satisfying surgical outcomes, this approach has been criticized as it produces extensive damage to the knee extensor muscle mechanism, and it may negatively affect the patellar blood supply [45]
The initial literature search resulted in 2218 articles, of which 592 were duplicates. 1201 did not match the eligibility criteria and a further 371 did not report quantitative data under the outcomes of interest
Summary
The most common exposure for total knee arthroplasty (TKA) is the medial parapatellar arthrotomy (MPP) using standard incision surgery (SIS) [22]. Despite the satisfying surgical outcomes, this approach has been criticized as it produces extensive damage to the knee extensor muscle mechanism, and it may negatively affect the patellar blood supply [45]. A less invasive MPP which allowed to spare the quadriceps (quadriceps-sparing approach = QS) [30] and the limited- or mini-medial parapatellar approach (MMPP) [50]. The midvastus and subvastus [59] approaches became respectively the mini-midvastus (MMV) [15], and the mini-subvastus (MSV) [17]. MIS for TKA uses a surgical incision shorter than 14 cm, offering an attractive alternative for both surgeons and patients. Despite the large number of published studies comparing the MIS and
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