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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 21, Issue 10, pp 2412–2417 | Cite as

Faster recovery after minimally invasive surgery in total knee arthroplasty

  • Emmanuel ThienpontEmail author
Knee

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.

Keywords

Total knee replacement Minimally invasive surgery Medial parapatellar approaches Rehabilitation Recovery 

References

  1. 1.
    Arnout N, Victor J, Cleppe H, Soenen M, Van Damme G, Bellemans J (2009) Avoidance of patellar eversion improves range of motion after total knee replacement: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 17:1206–1210PubMedCrossRefGoogle Scholar
  2. 2.
    Barrack RL, Barnes CL, Burnett RS, Miller D, Clohisy JC, Maloney WJ (2009) Minimal incision surgery as a risk factor for early failure of total knee arthroplasty. J Arthroplasty 24:489–498PubMedCrossRefGoogle Scholar
  3. 3.
    Bonutti PM, Zywiel MG, Ulrich SD, Stroh DA, Seyler TM, Mont MA (2010) A comparison of subvastus and midvastus approaches in minimally invasive total knee arthroplasty. J Bone Joint Surg Am 92:575–582PubMedCrossRefGoogle Scholar
  4. 4.
    Cheng T, Liu T, Zhang G, Peng X, Zhang X (2010) Does minimally invasive surgery improve short-term recovery in total knee arthroplasty? Clin Orthop Relat Res 468:1635–1648PubMedCrossRefGoogle Scholar
  5. 5.
    Pl Chin, Foo LS, Yang KY, Yeo SJ, Lo NN (2007) Randomized controlled trial comparing the radiologic outcomes of conventional and minimally invasive techniques for total knee arthroplasty. J Arthroplasty 22:800–806CrossRefGoogle Scholar
  6. 6.
    Dalury F, Dennis DA (2005) Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 440:77–81PubMedCrossRefGoogle Scholar
  7. 7.
    Dalury DF, Mulliken BD, Adams MJ, Lewis C, Sauder RR, Bushey JA (2009) Early recovery after total knee arthroplasty performed with and without patellar eversion and tibial translation. A prospective randomized study. J Bone Joint Surg Am 91:1339–1343PubMedCrossRefGoogle Scholar
  8. 8.
    Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12PubMedGoogle Scholar
  9. 9.
    Juosponis R, Tarasevicius S, Smailys A, Kalesinskas RJ (2009) Functional and radiological outcome after total knee replacement performed with mini-midvastus or conventional arthrotomy: controlled randomized trial. Int Orthop 33:1233–1237PubMedCrossRefGoogle Scholar
  10. 10.
    Karachalios T, Giotikas D, Roidis N, Poultsides L, Bargiotas K, Malizos KN (2008) Total knee replacement performed with either a mini-midvastus or a standard approach: a prospective randomized clinical and radiological trial. J Bone Joint Surg Br 90:584–591PubMedGoogle Scholar
  11. 11.
    Karpman RR, Smith HL (2009) Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty: a prospective randomized study. J Arthroplasty 24:681–688PubMedCrossRefGoogle Scholar
  12. 12.
    Khanna A, Gougoulias N, Longo UG, Mafulli N (2009) Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin N Am 40:479–489CrossRefGoogle Scholar
  13. 13.
    Kim JG, Lee SW, Ha JK, Choi HJ, Yang SJ, Lee MY (2011) The effectiveness of minimally invasive total knee arthroplasty to preserve quadriceps strength: a randomized controlled trial. Knee 18:443–447PubMedCrossRefGoogle Scholar
  14. 14.
    King J, Stamper DL, Schaad DC, Leopold SS (2011) Is minimally invasive total knee arthroplasty associated with lower costs than traditional TKA? Clin Orthop Relat Res 469:1716–1720PubMedCrossRefGoogle Scholar
  15. 15.
    King J, Stamper DL, Schaad DC, Leopold SS (2007) Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty. Assessment of the learning curve and the postoperative recuperative period. JBJS Am 89:1497–1503PubMedCrossRefGoogle Scholar
  16. 16.
    Lee DH, Choi J, Nha KW, Kim HJ, Han SB (2011) No difference in early functional outcomes for mini-midvastus and limited medial parapatellar approaches in navigation-assisted total knee arthroplasty: a prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 19:66–73PubMedCrossRefGoogle Scholar
  17. 17.
    Lee MS, Yim M, Wages J, Nakasone C (2011) Component alignment after minimally invasive total knee arthroplasty: results of the first 100 cases performed. J Arthroplasty 26:926–930PubMedCrossRefGoogle Scholar
  18. 18.
    Lin WP, Lin J, Hornh LC, Chang SM, Jiang CC (2009) Quadriceps-sparing, minimal-incision total knee arthroplasty: a comparative study. J Arthroplasty 24:1024–1032PubMedCrossRefGoogle Scholar
  19. 19.
    Lüring C, Beckmann J, Haiböck P, Perlick L, Grifka J, Tingart M (2008) Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomized trial. Knee Surg Sports Traumatol Arthrosc 16:928–934PubMedCrossRefGoogle Scholar
  20. 20.
    Majima T, Niskiike O, Sawaguchi N, Susuda K, Minami A (2011) Patella eversion reduces early knee range of motion and muscle torque recovery after total knee arthroplasty: comparison between minimally invasive total knee arthroplasty and conventional total knee arthroplasty. Arthritis 2011:854651PubMedCrossRefGoogle Scholar
  21. 21.
    Nestor BJ, Toulson CE, Backus SI, Lyman SL, Foote KL, Windsor RE (2010) Mini-midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty. J Arthroplasty 25(Suppl 6):5–11PubMedCrossRefGoogle Scholar
  22. 22.
    Niki Y, Mochizuki T, Momohara S, Saito S, Toyama Y, Matsumoto H (2009) Is minimally invasive surgery in total knee arthroplasty really minimally invasive surgery? J Arthroplasty 24:499–504PubMedCrossRefGoogle Scholar
  23. 23.
    Roidis NT, Karachalios TS, Malizos KN, McPherson EJ (2007) Incision stretching in primary TKA: what is the real length of our approach? Orthopedics 30:397–398PubMedGoogle Scholar
  24. 24.
    Schroer WC, Diesfeld PJ, Reedy ME, Lemarr AR (2008) Surgical accuracy with the mini-midvastus total knee arthroplasty a computer tomography scan analysis of postoperative implant alignment. J Arthroplasty 23:543–549PubMedCrossRefGoogle Scholar
  25. 25.
    Smith TO, King JJ, Hing CB (2012) A meta-analysis of randomised controlled trials comparing the clinical and radiological outcomes following minimally invasive to conventional exposure for total knee arthroplasty. Knee 19:1–7PubMedCrossRefGoogle Scholar
  26. 26.
    Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamoto Y (2007) Minimally invasive versus standard approach in total knee arthroplasty. Clin Orthop Relat Res 463:144–150PubMedGoogle Scholar
  27. 27.
    Tsuji S, Tomita T, Fujii M, Laskin RS, Yoshikawa H, Sugamoto K (2010) Is minimally invasive surgery-total knee arthroplasty truly less invasive than standard total knee arthroplasty? A quantitative evaluation. J Arthroplasty 25:970–976PubMedCrossRefGoogle Scholar
  28. 28.
    Van Hemert WL, Senden R, Grimm B, van der Linde MJ, Lataster A, Heyligers IC (2011) Early functional outcome after subvastus or parapatellar approach in knee arthroplasty is comparable. Knee Surg Sports Traumatol Arthrosc 19:943–951PubMedCrossRefGoogle Scholar
  29. 29.
    Varnell MS, Bhowmik-Stoker M, McCamley J, Jacofsky MC, Campbell M, Jacofsky D (2011) Difference in stair negotiation ability based on TKA surgical approach. J Knee Surg 24:117–123PubMedCrossRefGoogle Scholar
  30. 30.
    Watanabe T, Muneta T, Ishizuki M (2009) Is a minimally invasive approach superior to a conventional approach for total knee arthroplasty ? Early outcome and 2- to 4-year follow-up. J Orthop Sci 14:589–595PubMedCrossRefGoogle Scholar
  31. 31.
    Walter F, Haynes MB, Markel DC (2007) A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty 22:509–514PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySaint Luc University HospitalBrusselsBelgium

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