Faster recovery after minimally invasive surgery in total knee arthroplasty
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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.
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.
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).
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.
KeywordsTotal knee replacement Minimally invasive surgery Medial parapatellar approaches Rehabilitation Recovery
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