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The John Insall Award: No Benefit of Minimally Invasive TKA on Gait and Strength Outcomes: A Randomized Controlled Trial

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

While some clinical reports suggest minimally invasive surgical (MIS) techniques improve recovery and reduce pain in the first months after TKA, it is unclear whether it improves gait and thigh muscle strength.

Questions/Purposes

We hypothesized TKA performed through a mini-subvastus approach would improve subjective and objective and subjective function compared to a standard medial parapatellar approach 2 months after surgery.

Methods

We randomized 40 patients into two groups using either the mini-subvastus approach or standard medial parapatellar approach. Patients were evaluated preoperatively and 2 months after surgery. We assessed subjective functional outcome and quality of life (QOL) using routine questionnaires (SF-12, Knee Society Score [KSS], Knee Injury and Osteoarthritis Outcome Score [KOOS], UCLA activity, patient milestone diary of activities). We determined isometric strength of the thigh muscles and assessed gait with a three-dimensional (3-D) analysis during level walking and stair climbing.

Results

We observed improvements from preoperatively to 2 months postoperatively in functional scores, QOL, and knee kinematic and kinetic gait parameters during level and stair walking. Isometric quadriceps strength increased in both groups, although remaining lower when compared to sound limbs. We found no differences between the groups in KSS, SF-12, KOOS, UCLA activity, patient milestone diary of activities, isometric quadriceps strength, or 3-D gait parameters, except a marginally higher speed of stair ascent in the MIS group.

Conclusions

Our observations suggest an MIS approach does not confer a substantial advantage in early function after TKA.

Level of Evidence

Level I, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Mrs. Barbara Iverson for her assistance in manuscript preparation.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Julien Wegrzyn MD, PhD, Sebastien Parratte MD, PhD, Krista Coleman-Wood PhD, PT & Mark W. Pagnano MD

  2. Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Julien Wegrzyn MD, PhD, Sebastien Parratte MD, PhD, Krista Coleman-Wood PhD, PT & Kenton R. Kaufman PhD, PE

Authors
  1. Julien Wegrzyn MD, PhD
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  2. Sebastien Parratte MD, PhD
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  3. Krista Coleman-Wood PhD, PT
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  4. Kenton R. Kaufman PhD, PE
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  5. Mark W. Pagnano MD
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Corresponding author

Correspondence to Kenton R. Kaufman PhD, PE.

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his/her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Wegrzyn, J., Parratte, S., Coleman-Wood, K. et al. The John Insall Award: No Benefit of Minimally Invasive TKA on Gait and Strength Outcomes: A Randomized Controlled Trial. Clin Orthop Relat Res 471, 46–55 (2013). https://doi.org/10.1007/s11999-012-2486-1

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  • DOI: https://doi.org/10.1007/s11999-012-2486-1

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