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Does Minimally Invasive Surgery Improve Short-term Recovery in Total Knee Arthroplasty?

  • Clinical Research
  • Knee
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Concerns have been raised regarding minimally invasive surgery (MIS) and its possible effect on postoperative functional recovery, complications, and survival rate after TKA.

Questions/purposes

We specifically asked whether MIS TKA would be associated with (1) increased operative time, (2) reduced blood loss, (3) shortened hospital stay, (4) faster recovery of ROM, (5) higher knee scores, (6) inferior component positioning, and (7) increased complications.

Methods

We performed a systematic literature search of randomized controlled trials between minimally invasive and standard approaches in TKA that compared operative time, blood loss, ROM, knee scores, component positioning, and complications. We conducted a systematic review and meta-analysis of 13 trials published from 2007 to 2009 of MIS versus standard TKA.

Results

Patients in the MIS group had longer operating times (10–19 minutes). Mean Knee Society scores were better after MIS than after the standard procedure at 6 and 12 weeks postoperatively, but not after 6 months. Improvement in ROM occurred more rapidly in the MIS group 6 days after TKA but later improvements are not clearly documented. We identified no differences between minimally invasive and standard approaches regarding the short-term overall complications and alignment of femoral and tibial components. However, wound healing problems and infections occurred more frequently in the MIS group.

Conclusions

MIS leads to faster recovery than conventional surgery with similar rates of component malalignment but is associated with more frequent delayed wound healing and infections. Potential benefits in long-term survival rate and functional improvement require additional investigation.

Level of Evidence Level II, therapeutic study (systematic review). See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank all corresponding authors from the studies we used in this meta-analysis for their assistance in obtaining additional data that contributed to our study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China

    Tao Cheng MD, PhD, Xiaochun Peng MD, PhD & Xianlong Zhang MD, PhD

  2. Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China

    Tao Liu MD, PhD

  3. Department of Hand and Plastic Surgery, Second Affiliated Hospital, Wenzhou Medical College, Wenzhou, Zhejiang Province, People’s Republic of China

    Guoyou Zhang MD, PhD

Authors
  1. Tao Cheng MD, PhD
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  2. Tao Liu MD, PhD
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  3. Guoyou Zhang MD, PhD
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  4. Xiaochun Peng MD, PhD
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  5. Xianlong Zhang MD, PhD
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Corresponding author

Correspondence to Xianlong Zhang MD, PhD.

Additional information

One of more of the authors (TC and XZ) received funding from the Doctoral Students Innovation Fund of Shanghai Jiao Tong University School of Medicine (BXJ0930) and New Medical Technology Development Program of Shanghai Shenkang Hospital Development Center (SHDC12006103).

Each author certifies that he or she 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.

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Cheng, T., Liu, T., Zhang, G. et al. Does Minimally Invasive Surgery Improve Short-term Recovery in Total Knee Arthroplasty?. Clin Orthop Relat Res 468, 1635–1648 (2010). https://doi.org/10.1007/s11999-010-1285-9

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  • DOI: https://doi.org/10.1007/s11999-010-1285-9

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