Approach In Total Knee Arthroplasty Research Articles

Computerized Versus Traditional Approaches for Total Knee Arthroplasty: A Quantitative Analysis of Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index.

Total knee arthroplasty (TKA) is a common surgery for osteoarthritis, with increasing prevalence expected in the near future. This systematic review and meta-analysis compared the effectiveness of computerized TKA versus traditional TKA, focusing on postoperative outcomes measured by the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and the Knee Society score (KSS). A search on PubMed and Cochrane databases on November 14, 2023 for retrospective randomized controlled trials (RCTs) yielded data on WOMAC and KSS. The search strategy was predefined, and methodological quality of studies was critically appraised. Two researchers extracted data. Unpaired t-testing assessed the mean monthly changes in KSS and WOMAC for computer-aided versus traditional TKA. Review Manager 5.3 was used for data synthesis and analysis. Out of 729 records, five RCTs enrolling 339 patients were eligible and analyzed using a random effects meta-analysis. The mean monthly ΔKSS score differed significantly between the traditional and computerized groups (11.47 ± 8.76 vs. 9.26 ± 6.05, respectively; p < 0.01). However, the pooled mean difference estimate showed no significant differences (D = 0.20, 95% CI = -0.53 to 0.93, p = 0.59), with high heterogeneity (I2 = 85%, p < 0.001). The mean monthly ΔWOMAC score also differed significantly (-14.18 ± 21.54 vs. -18.43 ± 20.65, respectively; p < 0.05), but again, no significant differences were found in the pooled estimate (D = 0.17, 95% CI = -0.46 to 0.79, p = 0.60), with moderate heterogeneity (I2 = 28%, p = 0.24).There is no significant difference in KSS or WOMAC outcomes between traditional and computerized TKA. The study suggests the need for further research with longer follow-up periods, more timepoints, and a broader range of patient outcome measures to fully evaluate the advantages and disadvantages of each method.

Compare the Quadriceps Activity between Mini-Midvastus and Mini-Medial Parapatellar Approach in Total Knee Arthroplasty with Electromyography.

Background: The comparison between the mini-midvastus (mini-MV) and mini-parapatellar (mini-MPP) approach in total knee arthroplasty (TKA) remains a subject of debate. The present study compared quadriceps activation, pain levels, and clinical outcomes between the two approaches; quadricep activation was assessed using surface electromyography (sEMG). Methods: This retrospective cross-sectional study comprised a total of 78 patients aged between 50 and 85 years with primary osteoarthritis. Patients were divided into a mini-MV (n = 38) group and a mini-MPP (n = 40) group according to the surgical approach. Results: The two groups exhibited no significant differences in sEMG for the vastus medialis (VM) or rectus femoris (RF) at the follow-up time points, with the exception that the mini-MV group exhibited superior strength of RF during extensions at the 2-week follow-up. However, the mini-MPP group had superior Western Ontario and McMaster Universities Index (WOMAC) total and function scores at the 2- and 6-week follow-ups. The mini-MPP group also had superior WOMAC stiffness scores at the 2-week follow-up. The two groups did not differ significantly in terms of pain levels or morphine consumption. Conclusions: The sEMG data of quadriceps muscle would not differ significantly between the mini-MV and mini-MPP approaches for TKA. Moreover, the mini-MPP approach may yield superior WOMAC scores when compared with the mini-MV approach.

Lateral Subvastus Lateralis versus Medial Parapatellar Approach for Total Knee Arthroplasty: Patient Outcomes and Kinematics Analysis.

The conventional approach for total knee arthroplasty (TKA) is a medial parapatellar approach (MPA). We aimed to study patient outcomes and kinematics with a quadriceps sparing lateral subvastus lateralis approach (SLA). Patients with neutral/varus alignment undergoing primary TKA were consented to undergo the SLA. At 1-year postoperative, patients underwent radiostereometric analysis. Patients were administered the Short Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Society Score (KSS). Kinematics and outcome data were compared to a group undergoing TKA via conventional MPA. Fourteen patients underwent TKA via SLA with a mean age 71.5 ± 8.0 and mean body mass index (BMI) 31.0 ± 4.5. The MPA group had 13 patients with mean age 63.4 ± 5.5 (p = 0.006) and mean BMI 31.2 ± 4.6 (p = 0.95). The SLA resulted in a significantly more posterior medial contact point at 0 (p = 0.011), 20 (p = 0.020), and 40 (p = 0.039) degrees of flexion. There was no significant difference in medial contact point from 60 to 120 degrees, lateral contact point at any degree of flexion, or axial rotation. There was no difference in improvement in postoperative WOMAC, SF-12, KSS function, and total KSS knee scores between groups. The MPA group had a significantly greater improvement in KSS knee scores at 3 months (p < 0.001), 1 year (p = 0.003), and 2 years (p = 0.017). The SLA resulted in increased medial femoral rollback early in flexion. Although both approaches resulted in improved postoperative outcomes, the MPA group showed significantly greater improvements in KSS knee scores at 3 months, 1 year, and 2 years. Further studies are required to identify any benefits that the SLA may offer. LEVEL OF EVIDENCE: Therapeutic Level II.

Water-Tight Arthrotomy Joint Closure of Modified Intervastus Approach in Total Knee Arthroplasty.

The joint closure technique used for total knee arthroplasty cases can have an impact on outcomes, especially when considering accelerated rehabilitation programs that follow surgery. In this study, we describe the details of the technical steps involved in performing the water-tight arthrotomy joint closure technique that we developed and use. A total of 536 patients (average age: 62 years, average body mass index: 34 kg/m2) with primary osteoarthritis of the knee underwent total knee arthroplasty using the modified intervastus approach between 2019 and 2021. We used the water-tight arthrotomy joint closure technique to close the knee arthrotomy incision. Any infections and complications, as well as the duration of surgery and cost related to this wound closure technique, are also reported. Few complications were noted with this closure technique. When we first started using it, there was one case of drainage through the proximal capsular repair which required a return to the operating room 5 days postoperatively for an irrigation and debridement. We also had two cases of superficial skin necrosis along a small part of the incision line which were observed on a weekly basis and which healed uneventfully with application of betadine once daily on the necrotic area. The average time for performing wound closure after total knee arthroplasty was 45 min. We conclude that the water-tight closure approach can achieve very durable, water-tight capsule repairs and results in a decrease in postoperative wound drainage.

A study to assess the clinical and functional outcome of sub-vastus approach for total knee arthroplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Osteoarthritis and rheumatoid arthritis affects all patients of age more than 50 years, requiring total knee replacement. There are two major approaches to total knee replacement- sub-vastus approach and medial parapatellar approach. There is no common consensus on superiority of sub-vastus approach. So, we undertook the present study to evaluate the functional and clinical outcome of total knee replacement via sub-vastus approach in terms of knee society clinical and functional scores and visual analog scale along with monitoring of range of motion in the post-operative knee in the follow up period.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The present prospective and observational study was conducted in the Department of Orthopaedics, Unique Super Speciality Hospital, Indore, Madhya Pradesh for a period of 12 from June 2019-May 2020 with sample size of 30 patients undergoing total knee arthroplasty. All the patients had undergone total knee replacement via sub-vastus approach. The functional and clinical results of our study were compared with available literature.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean KFS and KCS scores showed a statistically significant improvement over a period of 12 months (p&amp;lt;0.05), while the mean ROM showed an improvement till 6 months (p&amp;lt;0.05) and then it remained stable till 12 months in comparison to 6 months (p&amp;gt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;On comparing the results of sub-vastus approach with the available literature we found a significant improvement in functional and clinical outcome with a stable improvement in range of motion with very few complications.&lt;/p&gt;

SMOC approach for total knee arthroplasty in valgus knees

ObjectiveThis study was performed to compare clinical outcomes among patients with valgus knees undergoing total knee arthroplasty via the medial parapatellar approach and the subvastus with minimal oblique cut approach.MethodsA total of 232 patients (246 knees) undergoing total knee arthroplasty between December 2014 and December 2016 were retrospectively included in the investigation. The study population consisted of 120 patients (128 knees; 32 men and 88 women) with a mean age of 62.43 ± 8.12 years treated via the medial parapatellar approach, and 112 patients (118 knees; 30 men and 82 women with a mean age of 63.15 ± 7.83 years) treated via the subvastus with minimal oblique cut approach. Nine preoperative parameters (number of patients, sex, age, body mass index, number of knees, valgus angle, visual analogue scale score, range of motion, Hospital for Special Surgery score), five perioperative parameters (operative time, amount of drainage, Visual analogue scale score at 24 h after the operation, time to straight leg raising, radiological alignment), and two postoperative parameters (range of motion, Hospital for Special Surgery score) were assessed at 1 day, 1 week, 6 weeks, 8 weeks and 1 year after the operation, along with postoperative complications.ResultsThere were no significant differences in the nine preoperative parameters between the two groups. The subvastus with minimal oblique cut group had a longer operative time, while the parapatellar approach group showed more drainage and a higher mean Visual analogue scale score. Compared to the medial parapatellar group, the subvastus with minimal oblique cut group had a shorter time to straight leg raising. There were no differences in radiological alignment between the two groups. The groups showed similar range of motion and Hospital for Special Surgery scores at 8 weeks and 1 year, but both were higher in the subvastus with minimal oblique cut group at 1 day, 1 week and 6 weeks. During postoperative follow-up, postoperative subluxation of the patella occurred in five cases in the medial parapatellar group. Neither group showed any instability, recurrent valgus deformity or radiographic loosening.ConclusionThe subvastus with minimal oblique cut approach provides excellent early recovery for total knee arthroplasty of valgus knees with no increase in complications.

Subvastus approach versus medial parapatellar approach in total knee arthroplasty – A prospective comparative study of functional outcome

Subvastus approach versus medial parapatellar approach in total knee arthroplasty – A prospective comparative study of functional outcome

Comparison of effects of medial parapatellar and subvastus bilateral simultaneous approaches in total knee arthroplasty

BackgroundTotal knee arthroplasty is the prevalent surgical intervention being used to treat knee osteoarthritis. Although the medial parapatellar approach is the prominent surgical approach, the parapatellar incision has concerning theoretical risks. The subvastus approach is a less invasive, but less commonly used alternative. The aim of this study is to compare the post-operative outcomes of these two surgical approaches with respect to retropatellar knee pain, knee range of motion, and quadriceps muscle strength at 6 and 12 months post-operation. MethodsIn this randomized controlled trial, 50 patients who suffered from advanced osteoarthritis in both knees underwent simultaneous bilateral total knee arthroplasty, one using the medial parapatellar approach and the other using the subvastus approach. Retropatellar knee pain, quadriceps muscle strength and knee range of motion were assessed pre-operation, as well as at 6 and 12 months post-operation. ResultsThis study found no statistically significant differences in retropatellar knee pain, quadriceps muscle strength, or knee range of motion between the medial parapatellar and subvastus approaches at 6 and 12 months post-operation. ConclusionThe results of this study provide further evidence that the subvastus approach is a comparable alternative to the medial parapatellar approach, but do not indicate any advantages to one over the other. More research is necessary in order to determine if there is an added benefit to the subvastus approach in the short term (<3 months).

The Eeklo Modified Subvastus Approach for Total Knee Arthroplasty: Detailed Surgical Tips and Tricks

This paper describes step by step a modified Far Medial Subvastus approach-the Eeklo Modified Subvastus approach (EMS)-for Total Knee Arthroplasty (TKA). The EMS approach is a modification of the classic Subvastus approach. It provides excellent exposure of the knee joint with preservation of all peri-articular soft tissues.

Does the type of surgical approach affect the clinical outcome of total knee arthroplasty?

BackgroundThe aim of the study was to investigate the issue of medial midvastus (MMV) vs. medial parapatellar (MPP) approaches in total knee arthroplasty (TKA). It was hypothesized that the two surgical approaches would produce significantly different results with respect to patient-reported knee score outcome (hypothesis 1), short-term postoperative range of motion (ROM) (hypothesis 2), long-term postoperative ROM (hypothesis 3) and prosthesis survival (hypothesis 4).MethodsA retrospective comparative study design was applied. Data sets were obtained from the state arthroplasty registry. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) data were analyzed from preoperative and 1 year postoperatively. The ROM data were analyzed for the time points preoperative, postoperative days 4 and 10 and 1 year.ResultsAvailable were 627 cases (407 MMV vs. 220 MPP) and 1 year postoperatively there were no significant differences between groups regarding the WOMAC scores (hypothesis 1). Early postoperatively on days 4 and 10 after TKA there were no differences between groups (p = 0.305 and p = 0.383, respectively, hypothesis 2). Likewise, ROM did not significantly differ between the groups 1 year after TKA (p = 0.338, hypothesis 3). The 5‑year prosthesis survival did not differ between the groups and showed 94.46% (95% confidence interval, CI 90.69–96.73%) in the MMV group and 94.33% (95% CI 89.96–96.83%) in the MPP group (p = 0.664, hypothesis 4).ConclusionBoth surgical approaches produce equivalent clinical results in terms of early postoperative ROM, late postoperative ROM and 1‑year WOMAC. The same prosthesis survival rates can be expected.

Anesthetic and analgesic approach in total knee arthroplasty: A national survey study

Aim: Although the optimum anesthetics and analgesic choice for total knee arthroplasty is a heavily debated topic in recent years, the failure to reach any ideal consensus on this topic leads clinicians to adopt different approaches. This study was conducted to assess differences in general anesthetic and analgesic approaches toward the total knee arthroplasty across Turkey. Materials and Methods: Our 28-item survey was presented online to physicians who work as Anesthesiology and Reanimation specialists in Turkey and agreed to participate in the study. The survey includes questions about the techniques preferred by the clinicians in the management of anesthesia and postoperative analgesia in TKA and the main reasons underlying their preferences. Results: 255 anesthesiologists, i.e. 72 (28.1%) faculty members and 183 (71.9%) specialists, completed the study in full. According to our survey, spinal anesthesia (61.3%) comes first in the selection of an anesthetic method in TKA, followed by the Combined Spinal-Epidural Anesthesia (32.4%). The spinal anesthesia is the most frequently preferred method in training and state hospitals and Combined Spinal-Epidural Anesthesia is the most frequently preferred method in private hospitals. The use of peripheral nerve blocks is 49.8% (127). Femoral nerve block is preferred with 79.7%, followed by adductor canal block with 36.1%. The rate of use of intravenous patient-controlled analgesia is 38.1% and the most commonly preferred analgesia is Tramadol (69.1%). 63.1% of those using epidural anesthesia do not use any epidural patient-controlled analgesia device. The physicians reported that the lack of a team to follow up epidural patient-controlled analgesia device (50.9%) as the most common reason for not choosing epidural patient-controlled analgesia. Conclusion: Regional anesthesia is the first preference in the anesthesia management of total knee arthroplasty in our country. In postoperative analgesia practice, peripheral nerve blocks are preferred at a higher rate than epidural and intravenous patient-controlled analgesia.

Comparative Efficacy of the Different Surgical Approaches in Total Knee Arthroplasty: A Systematic-Review and Network Meta-Analysis

BackgroundSeveral 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). MethodsRandomised 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. ResultsSixty 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. ConclusionNo 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 EvidenceNetwork meta-analysis. Level 1.

Mini-midvastus versus medial parapatellar approach in total knee arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score

BackgroundLow 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.MethodsFrom 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.ResultsThere 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).ConclusionWhen 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.

Comparable outcomes in mini-midvastus versus mini-medial parapatellar approach in total knee arthroplasty: a meta-analysis and systematic review.

Minimally invasive surgery (MIS) techniques in total knee arthroplasties (TKA) have gained popularity over conventional techniques due to benefits of hastened recovery and reduced complications. There are a variety of MIS techniques available and two most common techniques currently employed are the mini-midvastus (mMV) and mini-medial parapatellar (mMPP) approaches. This meta-analysis aims to compare the clinical outcomes and peri-operative parameters between mMV and mMPP in TKA in order to determine the presence of a superior technique. A multi-database search was performed according to PRISMA guidelines. Data from studies comparing clinical outcomes and peri-operative parameters between mMV and mMPP approaches in TKA were extracted and analysed. A total of five randomized controlled trials were included for analysis, consisting of 190 mMV and 189 mMPP knees. Clinically unimportant differences were noted in blood loss and surgical time between the groups (5 mL less blood loss and 7 min less surgical time in mMV, P < 0.001). There was no statistically significant difference between both groups for Knee Society Score at 1 and 2 years, range of motion at 1 and 2 years, incision length or incidence of lateral retinacular release (all non-significant, P > 0.05). The mMV and mMPP MIS TKA approaches have equivalent clinical outcomes. Despite a statistically significant longer operative time and higher mean blood loss in mMV than mMPP approach, clinically significant difference was not demonstrated. Both mMV and mMPP MIS techniques are reliable and safe to perform in TKA.

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.

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. 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. 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. 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.

Incidence of Encountering the Infrapatellar Nerve Branch of the Saphenous Nerve During a Midline Approach for Total Knee Arthroplasty.

Background:The infrapatellar nerve branch (IPNB) of the saphenous nerve supplies cutaneous sensation to the anterolateral knee. Given its location and variable course, the IPNB is suspected to be at risk of injury with commonly used incisions around the knee. Nerve injury may lead to painful neuroma formation. To our knowledge, no study has evaluated the incidence at which the IPNB is encountered during the anterior approach incision for a routine total knee arthroplasty (TKA). The purpose of this study was to see whether the general joint arthroplasty surgeon can identify and examine the location of the IPNB encountered during primary TKA and to determine whether these branches would be transected during a standard medial arthrotomy.Methods:Seventy-three patients (76 knees) underwent primary TKA using a standard midline approach with a medial parapatellar arthrotomy. The IPNB was identified, and the distance was measured from the inferior pole of the patella to the point where the nerve crossed the medial border of the patellar tendon. This distance was then compared with the length of the arthrotomy in the same knee to determine whether the nerve would be transected.Results:The IPNB was encountered in all knees with a mean distance of 2.82 cm (95% confidence interval, 2.58–3.06) distal to the inferior pole of the patella during the arthrotomy. Patient characteristics including sex, height, and body mass index were not markedly associated with nerve location.Conclusion:The IPNB of the saphenous nerve is at risk for injury and routinely encountered by the general orthopaedic surgeon during a standard TKA medial parapatellar approach without the aid of magnification or dye.

Bilateral Simultaneous vs Staged Total Knee Arthroplasty: Minimal Difference in Perioperative Risks

BackgroundWith the rising utilization of total joint arthroplasty, the role of simultaneous-bilateral surgery will have an expanding impact. The purpose of this study is to examine the risks of perioperative complications with this approach in total knee arthroplasty (TKA), to inform shared decision-making. MethodsWe reviewed national hospital discharge data from 2005 to 2014 to compare outcomes between simultaneous-bilateral TKAs (sim-BTKAs) and staged-bilateral TKAs (staged-BTKAs). Hierarchical logistic regression analyses were used to adjust for confounders. Outcomes analyzed included mortality, various medical complications, knee infection, and mechanical complications. ResultsThis study analyzed 27,301 sim-BTKAs and 45,419 staged-BTKAs. Patients who underwent simultaneous surgery had a statistically significant higher adjusted odds of mortality, cardiac events, thromboembolic events, and complications involving the urinary and digestive systems, and a lower adjusted odds of deep knee infection and hematoma. Thirteen of the 14 complications had overall incidences less than 2% and 1 outcome had an incidence of 3%. The absolute between-group risk difference for any complication was 1% or less. ConclusionSim-BTKAs have a statistically significant increased odds of multiple complications compared to staged-BTKAs. However, the absolute risk differences between these options are minimal and the occurrence of any complication is low. Level of EvidenceTherapeutic Level III.

Lateral parapatellar approach in total knee arthroplasty for valgus knee: an update

Lateral parapatellar approach in total knee arthroplasty for valgus knee: an update

Quadriceps-sparing versus traditional medial parapatellar approaches for total knee arthroplasty: a meta-analysis

BackgroundThere is still controversy regarding whether Quadriceps-sparing (QS) approach for total knee arthroplasty (TKA) lead to better earlier recovery as well as compromising low limb alignment and prosthesis position compared with conventional medial parapatellar (MP) approach. To overcome the shortcomings and inaccuracies of single studies, the clinical outcomes and radiographic assessments of QS approach and MP approach were evaluated through meta-analysis.MethodsWe performed this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A literature search was conducted in the PubMed, EMBase, Cochrane Collaboration Library and Web of Science databases. Our search strategy followed the requirements of the Cochrane Library Handbook. The study selection, data extraction and assessment of methodological quality were independently completed by four authors. And subgroup analysis and publication bias were also performed in the study.ResultsEight prospective randomized controlled trials (RCTs) and eight retrospective studies were identified. Overall meta-analysis and subgroup meta-analysis of RCTs identified the QS approach mainly was associated with increased Knee Society function score beyond 24 months postoperatively (weighted mean difference [WMD] 1.78, P = 0.0004) (WMD 1.86, P = 0.0002), and improved range of motion 1–2 weeks postoperatively (WMD 5.84, P < 0.00001) (WMD 4.87, P = 0.002). Besides, lower visual analogue scale on postoperative day 1 (WMD -0.91, P = 0.02), shorter hospital stay (WMD -0.88, P = 0.02) and shorter incision (extension) (WMD -4.62, P < 0.00001) were indicated in overall meta-analysis. However, surgical and tourniquet time was significantly longer in QS group by both overall and subgroup meta-analysis.ConclusionsQS approach may accelerate early recovery without increasing the risk of malalignment of low limb and malposition of prosthesis.

Early functional results of the subvastus and medial parapatellar approaches in total knee arthroplasty

Early functional results of the subvastus and medial parapatellar approaches in total knee arthroplasty