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Malavolta M, Carrozzo A, Mezzari S, Lista G, Residori A. Calipered Kinematically Aligned Medial Unicompartmental Knee Arthroplasty: A Surgical Technique. Arthroplast Today 2024; 29:101470. [PMID: 39188577 PMCID: PMC11345933 DOI: 10.1016/j.artd.2024.101470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 08/28/2024] Open
Abstract
This study presents a surgical technique for kinematically aligned medial unicompartmental knee arthroplasty with the MOTO (Medacta Corporate, Switzerland) partial knee implant. This technique aims to replicate the native medial femoral and tibial morphology by providing caliper-verified bone resections and kinematic alignment principles. The paper provides a comprehensive overview of the surgical steps and discusses the implications for implant longevity.
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Affiliation(s)
| | - Alessandro Carrozzo
- La Sapienza University, Dipartimento di Sanità Pubblica e Malattie Infettive, Rome, Italy
| | - Silvio Mezzari
- Department of Orthopedics, Casa di Cura Solatrix, Rovereto, Italy
- Department of Orthopedics and Trauma Surgery, Ospedale P. Pederzoli, Peschiera del Garda, Italy
| | - Gianpietro Lista
- Department of Orthopedics and Trauma Surgery, Ospedale P. Pederzoli, Peschiera del Garda, Italy
| | - Alberto Residori
- Department of Orthopedics and Trauma Surgery, Ospedale P. Pederzoli, Peschiera del Garda, Italy
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2
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Wang YC, Wu SH, Chen CA, Liang JM, Yang CC, Chen CH, Chung WR, Chou PPH, Huang HT. Compare the Quadriceps Activity between Mini-Midvastus and Mini-Medial Parapatellar Approach in Total Knee Arthroplasty with Electromyography. J Clin Med 2024; 13:2736. [PMID: 38792280 PMCID: PMC11122619 DOI: 10.3390/jcm13102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/18/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
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.
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Affiliation(s)
- Ying-Chun Wang
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Sheng-Hua Wu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.W.); (C.-A.C.)
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chi-An Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.W.); (C.-A.C.)
| | - Jing-Min Liang
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Chia-Chi Yang
- The Master Program of Long-Term Care in Aging, College of Nursing, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wan-Rong Chung
- Department of Anesthesiology, E-Da Hospital, Kaohsiung 807, Taiwan;
- College of Medicine, I-Shou University, Kaohsiung 807, Taiwan
| | - Paul Pei-Hsi Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsuan-Ti Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Lee PA, Wang TM, Chen YT, Wu KH, Liu HC, Lu TW. Mid-vastus total knee arthroplasty for medial osteoarthritis recovers gait balance control better than lateral parapatellar approach three months post-surgery. Front Bioeng Biotechnol 2023; 11:1133992. [PMID: 37034249 PMCID: PMC10073553 DOI: 10.3389/fbioe.2023.1133992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Total knee arthroplasty (TKA) approaches affect recovery outcomes, with different levels of residual loss of muscle strength and functional deficits. The current study compared the gait balance control in older individuals 3 months after TKA via the lateral parapatellar approach (LPPA) and mid-vastus approach (MVA) in terms of the inclination angle (IA) of the center of pressure (COP) to the body's center of mass (COM) vector, and the rate of change of IA (RCIA). In a gait laboratory, 12 patients with severe medial knee osteoarthritis who had undergone bilateral TKA via LPPA and 12 via MVA were evaluated and compared against 12 healthy controls for their balance control during gait 3 months after surgery. The participants' kinematic data and ground reaction forces were measured synchronously using an 8-camera motion capture system and three forceplates, respectively, from which the COM, COP, IA and RCIA were calculated using a 13-body-segment model. The LPPA group showed significantly greater sagittal IA during DLS (p < 0.01) but less sagittal and frontal RCIA throughout the gait cycle (p < 0.04) compared to controls. The MVA showed better recovery in the balance control with most IA and RCIA variables similar to those of the healthy controls throughout the gait cycle. The patients with LPPA walked with a compromised balance control throughout the gait cycle while the MVA group showed close-to-normal balance control with a slight decrease in sagittal RCIA during SLS. The current between-approach findings were likely related to the differences in the muscles involved during surgery, suggesting that MVA may be a better choice than LPPA when taking short-term gait balance control into consideration.
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Affiliation(s)
- Pei-An Lee
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Kuan-Hsien Wu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hwa-Chang Liu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopaedic Surgery, Taiwan Adventist Hospital National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Tung-Wu Lu, ; Hwa-Chang Liu,
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
- *Correspondence: Tung-Wu Lu, ; Hwa-Chang Liu,
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Zhao JL, Zeng LF, Pan JK, Liang GH, Huang HT, Yang WY, Luo MH, Liu J. Comparisons of the Efficacy and Safety of Total Knee Arthroplasty by Different Surgical Approaches: A Systematic Review and Network Meta-analysis. Orthop Surg 2022; 14:472-485. [PMID: 35128816 PMCID: PMC8927026 DOI: 10.1111/os.13207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022] Open
Abstract
The purpose of this network meta‐analysis was to investigate the efficacy and safety of total knee arthroplasty (TKA) considering seven different surgical approaches. Four databases (PubMed, Cochrane Library, EMBASE, Web of Science) were searched for clinical randomized controlled trials (RCTs) involving TKA with different surgical approaches. STATA 14.0 was used to construct network maps and publication bias graphs and conduct inconsistency tests, network meta‐analyses, and surface under the cumulative ranking (SUCRA) calculations. A total of 51 RCTs involving 4061 patients and 4179 knees from 18 countries were included. Among the seven surgical approaches, the midvastus approach (MV) was the top choice to reduce tourniquet use time, the subvastus approach (SV) had the shortest operation time, the mini‐midvastus approach (Mini‐SV) was associated with the least amount of time to achieve straight leg raise (SLR) after surgery, the mini‐medial parapatellar approach (Mini‐MP) reduced postoperative pain effects, and the medial parapatellar approach (MP) was the best approach to improve range of motion (ROM). Excluding the quadriceps‐sparing approach (QS), which was not compared, the use of the mini‐midvastus (Mini‐MV) may shorten the hospital stay. There were no significant differences in blood loss, postoperative complications, American Knee Society Score (AKSS) objective, or AKSS functional between the seven surgical approaches (P > 0.05).
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Affiliation(s)
- Jin-Long Zhao
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guagnzhou, China.,Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, China
| | - Ling-Feng Zeng
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jian-Ke Pan
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Gui-Hong Liang
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - He-Tao Huang
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guagnzhou, China.,Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, China
| | - Wei-Yi Yang
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Ming-Hui Luo
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jun Liu
- Guangdong Academy of Traditional Chinese Medicine, Research Team on Bone and Joint Degeneration and Injury, Guangzhou, China.,The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
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5
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Fillingham YA, Matonick JP, Mendoza V, Parvizi J. Comparing the Water-Tight Closure of Barbed and Conventional Suture Under Static and Dynamic Conditions in an Ex-Vivo Human Knee Arthrotomy Model. Arthroplast Today 2021; 12:1-6. [PMID: 34703862 PMCID: PMC8526417 DOI: 10.1016/j.artd.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background Barbed suture has become popular for closure of the arthrotomy and overlying tissues in total knee arthroplasty. STRATAFIX Symmetric PDS Knotless Tissue Control Device, a unique and novel barbed suture, with barbs formed integral to the suture core provides greater suture strength than the more common cut barbed suture designs. It is the only barbed suture commercially available with an indication in high tension areas, such as fascia. The purpose of this study was to evaluate the use of this novel barbed suture in the formation of a water-tight arthrotomy closure, using a continuous suture pattern, compared to conventional Coated VICRYL (polyglactin 910) Suture, using an interrupted suture pattern, in a cadaveric knee arthrotomy. Methods Twenty fresh-frozen cadaver knees underwent randomization to provide donor-paired matching of the knee arthrotomy closures using barbed suture in a continuous pattern or conventional suture in an interrupted pattern. Each specimen underwent 5 phases of testing that included 1) predynamic static leak testing; 2) dynamic motion leak testing; 3) postdynamic static leak testing; 4) suture release static leak testing; and 5) postsuture release dynamic motion leak testing, to assess the fluid leak rate. Results Under the initial static conditions, watertightness was similar for the 2 types of sutures. However, in all subsequent phases of testing, continuous barbed suture created a better watertight closure than interrupted conventional suture. Conclusions In this study, it was observed that closure of a knee arthrotomy using the novel barbed suture provided improved watertightness compared to conventional interrupted closure under dynamic conditions and suture release.
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Affiliation(s)
- Yale A Fillingham
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - John P Matonick
- Department of Preclinical Research, Ethicon Inc, Somerville, NJ, USA
| | - Vivienne Mendoza
- Department of Preclinical Research, Ethicon Inc, Somerville, NJ, USA
| | - Javad Parvizi
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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6
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Sidhu SP, Somerville LE, Sidhu AS, Willing RT, Teeter MG, Lanting BA. Does surgical approach affect patient outcomes of total knee arthroplasty? Can J Surg 2021; 64:E521-E526. [PMID: 34598930 PMCID: PMC8526133 DOI: 10.1503/cjs.010920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Surgical approaches for total knee arthroplasty (TKA) include the medial parapatellar (MPA), subvastus (SV), midvastus (MV), and lateral parapatellar approach (LPA); it remains unclear which approach is superior. METHODS Patients having undergone TKA at our institution were retrospectively organized into matched groups according to surgical approach (MPA, MV, SV, or LPA). Outcomes between the groups were compared using the Short-Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and range of motion (ROM) up to 2 years postoperative. RESULTS Sixty-eight MV patients, 8 SV patients, and 4 LPA patients were matched with groups of MPA patients. There was no difference in outcomes between the MPA and MV groups up to 2 years. The SV group had significantly higher SF-12 Physical Composite Score (PCS; p = 0.036) and WOMAC stiffness score (p = 0.014) at 2 years, but significantly lower flexion at 1 year (p = 0.022) than the MPA group. The LPA group had significantly lower SF-12 PCS (p = 0.011) and WOMAC function scores (p = 0.022) at 1 year than the MPA group. CONCLUSION There was no significant difference between the MPA and MV approach. The SV approach had some improved long-term outcomes over the MPA aproach (SF-12 and WOMAC), but had significantly lower flexion at 1 year. The LPA group showed inferior outcomes than the MPA group but had more severe valgus preoperative deformity (p = 0.024). Further studies are required to investigate the potential benefit of quadriceps-sparing approaches.
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Affiliation(s)
- Sahil Prabhnoor Sidhu
- From the Department of Orthopaedic Surgery, Western University, London, Ont. (S. Sidhu, Somerville, A. Sidhu, Willing, Teeter, Lanting)
| | - Lyndsay E Somerville
- From the Department of Orthopaedic Surgery, Western University, London, Ont. (S. Sidhu, Somerville, A. Sidhu, Willing, Teeter, Lanting)
| | - Aamir Sohail Sidhu
- From the Department of Orthopaedic Surgery, Western University, London, Ont. (S. Sidhu, Somerville, A. Sidhu, Willing, Teeter, Lanting)
| | - Ryan T Willing
- From the Department of Orthopaedic Surgery, Western University, London, Ont. (S. Sidhu, Somerville, A. Sidhu, Willing, Teeter, Lanting)
| | - Matthew G Teeter
- From the Department of Orthopaedic Surgery, Western University, London, Ont. (S. Sidhu, Somerville, A. Sidhu, Willing, Teeter, Lanting)
| | - Brent A Lanting
- From the Department of Orthopaedic Surgery, Western University, London, Ont. (S. Sidhu, Somerville, A. Sidhu, Willing, Teeter, Lanting)
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7
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Zhang L, Li X, Rüwald JM, Welle K, Schildberg FA, Kabir K. 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. Technol Health Care 2021; 29:557-574. [DOI: 10.3233/thc-192078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Affiliation(s)
- Li Zhang
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Xian Li
- Department of Orthopedic and Trauma Surgery, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing 100091, China
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Julian M. Rüwald
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Kristian Welle
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Frank A. Schildberg
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
| | - Koroush Kabir
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany
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Morelli I, Maffulli N, Brambilla L, Agnoletto M, Peretti GM, Mangiavini L. Quadriceps muscle group function and after total knee arthroplasty-asystematic narrative update. Br Med Bull 2021; 137:51-69. [PMID: 33517365 DOI: 10.1093/bmb/ldaa041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND This article systematically summarizes the present evidences, published in the last 20 years, regarding the pre- and post-operative factors, which may influence recovery of the function of the quadriceps muscle group following total knee arthroplasty (TKA). We following the PRISMA methodology, including meta-analyses and high-level evidence studies (prospective trials, and, when unavailable, retrospective studies). SOURCES OF DATA Pubmed and Cochrane databases: 582 articles were identified and 54 of them were selected. AREAS OF AGREEMENT Tourniquets inflated at high pressure exert a detrimental effect on the quadriceps muscle group. Faster quadriceps recovery takes place using mini-invasive approaches, an eight-week rehabilitation period including balance training and the use of nutraceuticals. AREAS OF DISAGREEMENT Pre-habilitation and pre-operative factors, analgesic methods and different TKA implants. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH Telerehabilitation seems a cost-effective tool for rehabilitation after TKA. Patients' optimization protocols before TKA should include standardized nutraceuticals intake.
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Affiliation(s)
- Ilaria Morelli
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Nicola Maffulli
- San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Via San Leonardo, 84125 Salerno, Italy.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, Staffordshire ST5 5BG United Kingdom.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, United Kingdom
| | - Lorenzo Brambilla
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Marco Agnoletto
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Giuseppe Maria Peretti
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, via Luigi Mangiagalli 31, 20133 Italy
| | - Laura Mangiavini
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, via Luigi Mangiagalli 31, 20133 Italy
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9
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Does mini-midvastus approach have an advantageous effect on rapid recovery protocols over medial parapatellar approach in total knee arthroplasty? Jt Dis Relat Surg 2020; 31:571-581. [PMID: 32962591 PMCID: PMC7607934 DOI: 10.5606/ehc.2020.76387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to compare the effects of mini- midvastus (MMV) versus medial parapatellar (MPP) approach on rapid recovery protocols during total knee arthroplasty (TKA). Patients and methods
This prospective, randomized, single- blinded study was performed in 54 patients (4 males, 50 females; mean age 64.1±6.4 years) diagnosed as primary knee osteoarthritis and planned for unilateral TKA between May 2018 and March 2019. Patients were randomly assigned as MMV (1 male, 26 females; mean age 65±6.4 years) and MPP (3 males, 24 females; mean age 63.2±6.3 years) groups. Rapid recovery TKA protocol and discharge criteria were assembled and all patients were evaluated preoperatively, and at postoperative first and third months. Length of hospital stay (LOS) was recorded for all patients. Hemoglobin and hematocrit values, radiologic assessment of alignment, knee range of motion (ROM), quadriceps muscle strength, Visual Analog Scale (VAS), 30-sec chair-stand test, stair-climb test, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form-36 (SF-36) were used for evaluations by blinded observers. Results
There was no significant difference in demographic variables between two groups. Operative time in MMV Group (78.1±2.7 min) was significantly longer than the MPP Group (65.9±2.6 min) (p<0.0005). LOSs in the MMV and MPP Groups were 27.6±3.1 hours and 29.1±6.7 hours with no significant difference. There was no statistically significant difference in postoperative measurements between groups in hemoglobin and hematocrit values, radiologic alignment of components, knee ROM, VAS, 30-sec chair-stand test, stair-climb test, WOMAC, KOOS, and SF-36 evaluations (p>0.05). In terms of quadriceps muscle strength gain, we could not find any difference between groups in pre- and postoperative difference of changes (p>0.05). Conclusion With the use of contemporary rapid recovery protocols during TKA, MMV approach had no superiority over MPP approach when quadriceps muscle strength, LOS, pain, function, and quality of life were assessed. Longer operative time in the MMV approach compared to MPP approach may be considered as a disadvantage.
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10
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Lin W, Niu J, Dai Y, Yang G, Li M, Wang F. Mini-midvastus versus medial parapatellar approach in total knee arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score. J Orthop Surg Res 2020; 15:336. [PMID: 32807190 PMCID: PMC7433095 DOI: 10.1186/s13018-020-01869-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background Low 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. Methods From 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. Results There 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). Conclusion When 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.
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Affiliation(s)
- Wei Lin
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Jinghui Niu
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yike Dai
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Guangmin Yang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Ming Li
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Fei Wang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Mora JP, Scuderi GR. Minimally Invasive Total Knee Arthroplasty: Does Surgical Technique Actually Impact the Outcome? Orthop Clin North Am 2020; 51:303-315. [PMID: 32498949 DOI: 10.1016/j.ocl.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A surgical approach to total knee arthroplasty has been at the forefront of many conversations. Surgeons used the medial parapatellar approach for its familiarity of anatomy, reliability, and ability to convert to a more extensile approach. This article reviews the current literature and information regarding the effect of surgical approach on patients' outcomes. The results of the limited medial parapatellar, subvastus, midvastus, and quadriceps-sparing approaches were analyzed. All techniques can provide adequate exposure with successful outcomes. It is recommended that a surgeon perform the approach with which they are most comfortable, because that will likely yield the best patient outcome.
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Affiliation(s)
- Jason P Mora
- Adult Reconstruction, Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell, Northwell Health Orthopaedic Institute at MEETH, 210 East 64th Street, 4th Floor, New York, NY 10065, USA
| | - Giles R Scuderi
- Adult Reconstruction, Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell, 130 East 77th Street, 11th Floor, New York, NY 10075, USA.
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12
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Migliorini F, Aretini P, Driessen A, El Mansy Y, Quack V, Tingart M, Eschweiler J. Better outcomes after mini-subvastus approach for primary total knee arthroplasty: a Bayesian network meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:979-992. [PMID: 32152747 PMCID: PMC8203553 DOI: 10.1007/s00590-020-02648-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/03/2020] [Indexed: 12/25/2022]
Abstract
Introduction Alternatives to the classical medial parapatellar (MPP) approach for total knee arthroplasty (TKA) include the mini-medial parapatellar (MMPP), mini-subvastus (MSV), mini-midvastus (MMV) and quadriceps-sparing (QS) approaches. The best approach has been not fully clarified. The purpose of the present study was to conduct a Bayesian network meta-analysis comparing these approaches. Materials and methods The present analysis was carried out according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. The databases search was performed in October 2019. All clinical trials comparing two or more approaches for primary TKA were considered for inclusion. The baseline comparability was evaluated through the analysis of variance (ANOVA) test. The statistical analysis was performed through the STATA software/MP. A Bayesian hierarchical random-effects model analysis was adopted in all the comparisons. Results Data from 52 articles (4533 patients) were collected. The mean follow-up was 20.38 months. With regard to diagnosis, gender, age and BMI, adequate baseline comparability was detected. The MSV approach ranked better concerning clinical scores (the lowest visual analogic scale, the higher KSS and KSFS) and functional outcomes (the shortest straight leg raise, the greatest degree of flexion and range of motion). Concerning perioperative data, the MSV evidenced the shortest hospital stay, while the MPP the shortest surgical duration and lowest estimated blood loss. Conclusion According to the main findings of the present study, the mini-subvastus approach for total knee arthroplasty demonstrated superior overall compared to the other approaches. Orthopaedic surgeons should consider this approach in the light of the evidence and limitations of this Bayesian network meta-analysis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Paolo Aretini
- Fondazione Pisana per la Scienza, Via Ferruccio Giovannini 13, 56017, Pisa, Italy
| | - Arne Driessen
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Yasser El Mansy
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Orthopaedic and Traumatology, Alexandria University, Alexandria, Egypt
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany
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13
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Onggo JR, Onggo JD, Hau R. Comparable outcomes in mini-midvastus versus mini-medial parapatellar approach in total knee arthroplasty: a meta-analysis and systematic review. ANZ J Surg 2020; 90:840-845. [PMID: 32062865 DOI: 10.1111/ans.15719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- James R Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Flinders Medical School, Flinders University, Adelaide, South Australia, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Northern Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Epworth Eastern Hospital, Melbourne, Victoria, Australia
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14
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Carroll C, Mahmood F. Risk of bias and the reporting of surgeons' experience in randomized controlled trials of total hip and total knee arthroplasty: A systematic review. J Eval Clin Pract 2019; 25:205-215. [PMID: 30375108 DOI: 10.1111/jep.13056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/05/2018] [Accepted: 10/03/2018] [Indexed: 01/04/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The potential bias introduced by surgeons' lack of comparable, relevant experience when performing the procedures in different arms of randomized controlled trials (RCTs) is arguably not well-managed or reported. The aim of this work was to review the frequency and nature with which surgeons' relevant experience is reported in RCTs of total hip (THA) and total knee arthroplasty (TKA), and to relate this to other risk of bias domains for this study design. METHODS A systematic review of RCTs comparing different minimally invasive procedures for TKA and comparisons of THA and hemiarthroplasty (HA). We searched MEDLINE, EMBASE, Science Citation Index, The Cochrane Library, Conference Proceedings Citation Index-Science (CPCI-S), Current Controlled Trials, and Clinical Trials.gov. RESULTS Seventy-five relevant RCTs were identified, 65 RCTs comparing minimally invasive with standard or other minimally invasive approaches to TKA, and 10 for THA compared with HA. Risk of bias based on the reported details of surgeons' relevant experience was categorized as low, high, or unclear. There was a clear distinction before and after 2009, with a substantial decrease in trials at high or unclear risk of bias after this date. There were no strong associations between this domain and other, standard risk of bias domains for RCTs. CONCLUSION The surgeons' relevant experience in an evaluated procedure is often poorly reported but has improved since 2009. The variable is not adequately captured by any other risk of bias domain. Future work should concentrate on conducting research on a much larger sample of studies and in procedures other than knee and hip arthroplasty.
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Affiliation(s)
- Christopher Carroll
- School of Health and Related Research (ScHARR), University of Sheffield, S1 4DA, UK
| | - Faizan Mahmood
- School of Health and Related Research (ScHARR), University of Sheffield, S1 4DA, UK
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15
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Ramkumar PN, Navarro SM, Haeberle HS, Ng M, Piuzzi NS, Spindler KP. No Difference in Outcomes 12 and 24 Months After Lower Extremity Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2018; 33:2322-2329. [PMID: 29567000 DOI: 10.1016/j.arth.2018.02.056] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A better understanding of how patient-reported outcome measures (PROMs) change after total knee and hip arthroplasties (TKA and THA) is needed to support the minimum arbitrary follow-up of 24-months required by orthopedic journals. Therefore, our purpose was to perform a systematic review and meta-analysis of the THA and TKA literature to determine if equivalence exists between 12- and 24-month outcomes data. METHODS A search was performed using the PubMed and EMBASE databases for primary and revision THA and TKA studies reporting PROMs data at both 12 and 24 months. Reports on PROMs for TKA and THAs were included for meta-analysis to detect statistical differences at 12 and 24 months. RESULTS A total of 15 reports from 9 TKA (n = 1564) and 6 THA (n = 740) reports were analyzed. The mean change between 12 and 24 months for Knee Society Score was 0.15 absolute points (95% confidence interval [CI]: 0.97-1.06, P = .13) and for Western Ontario and McMaster Universities Osteoarthritis index was 0.50 absolute points (95% CI: 0.94-1.07, P = .49). The mean change between 12 and 24 months for Harris Hip Score was 2.01 absolute points (95% CI: 0.94-1.1, P = .22) and for short form was 0.02 absolute points (95% CI: 0.92-1.08, P = .94). CONCLUSION No different outcomes were found within THA and TKA for 4 PROMs at 12- and 24-month follow-up. Although the findings from this study do not alleviate the need for collecting data from longer follow-up periods, there may not be additional value in collecting short-term outcomes data in routine practice at both 1 and 2 years.
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Affiliation(s)
- Prem N Ramkumar
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Sergio M Navarro
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX
| | - Heather S Haeberle
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX
| | - Mitchell Ng
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH; Instituto Universitario del Hospital Italiano, Buenos Aires, Argentina
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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16
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Koçak A, Özmeriç A, Koca G, Senes M, Yumuşak N, Iltar S, Korkmaz M, Alemdaroğlu KB. Lateral parapatellar and subvastus approaches are superior to the medial parapatellar approach in terms of soft tissue perfusion. Knee Surg Sports Traumatol Arthrosc 2018; 26:1681-1690. [PMID: 28835987 DOI: 10.1007/s00167-017-4690-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 08/18/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE The arthrotomy techniques of knee surgery may cause varying degrees of disruption to the tissue blood supply. The aim of this study was to investigate the effects of the medial parapatellar (MPPa), midvastus (MVa), subvastus (SVa) and lateral parapatellar (LPPa) approaches on regional tissue perfusion of the knee. METHODS In this experimental study, a total of 28 female rabbits were applied with four different arthrotomy techniques as Group MPPa, Group MVa, Group SVa and Group LPPa. The blood supply of the tissue around the knee was examined by scintigraphic imaging including the perfusion reserve and T max, and biochemical alteration of the oxidative stress parameters including malondialdehyde (MDA), fluorescent oxidation products (FlOPs), and histopathological findings were evaluated on tissue samples after 3 weeks. RESULTS The perfusion reserve was increased in all four groups compared to the healthy, contralateral knees. In the Group LPPa, the vascularity was significantly increased compared to the Group MPPa (p = 0.006). In the examination of biochemical parameters, the increase in MDA levels was statistically significant in the Group MPPa compared with the Group LPPa (p = 0.004), and in the Group MVa compared with the Group LPPa (p = 0.006). The increase in the value of MDA levels was striking in the Group MPPa and Group MVa compared with the control group (p = 0.004, p = 0.004, respectively). The increase in another oxidative stress parameter, the tissue FlOPs levels, was statistically significant in the Group MPPa compared with the control group (p = 0.035). CONCLUSION The LPPa and SVa caused less oxidative stress and less disruption of the muscle blood supply, in biochemical and scintigraphic parameters, compared to the MPPa and MVa. Therefore, in clinical practice, the SVa is preferable to the MPPa and MVa in total knee arthroplasty and the LPPa should be preferred more frequently in selected cases with critical soft tissue viability.
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Affiliation(s)
- Aykut Koçak
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, 06534, Ankara, Turkey
| | - Ahmet Özmeriç
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, 06534, Ankara, Turkey.
| | - Gökhan Koca
- Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mehmet Senes
- Department of Medical Biochemistry, Ankara Training and Research Hospital, Ankara, Turkey
| | - Nihat Yumuşak
- Department of Veterinary Pathology, Harran University, Şanlıurfa, Turkey
| | - Serkan Iltar
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, 06534, Ankara, Turkey
| | - Meliha Korkmaz
- Department of Nuclear Medicine, Ankara Training and Research Hospital, Ankara, Turkey
| | - Kadir Bahadır Alemdaroğlu
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, 06534, Ankara, Turkey
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Yang CP, Hsu KY, Chang YH, Chan YS, Shih HN, Chen ACY. Mid-term survivorship of cruciate-retaining versus posterior-stabilized total knee arthroplasty using modular mini-keel tibial implants. J Orthop Surg Res 2018; 13:35. [PMID: 29433583 PMCID: PMC5809852 DOI: 10.1186/s13018-018-0738-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background Reports of diverse outcomes in modular mini-keel tibial componentry for total knee arthroplasty (TKA) have raised concerns about early aseptic loosening. Cruciate-retaining (CR) prostheses, using mini-keel implants, have yet to be reported and compared to posterior-stabilizing (PS) designs. Methods A retrospective, case-matched study of 91 consecutive TKAs (n = 46 CR; n = 45 PS prostheses), using modular mini-keel tibial componentry with a 45-mm drop down stem extension, was conducted. The Knee Society Score functional survey, radiographic analysis including alignment and periprosthetic radiolucency, TKA prosthesis longevity, and surgical complications were reported and compared between CR and PS groups. Results The Knee Society Score at 5-year follow-up averaged 81.67 ± 11.97 and 80.12 ± 14.16 in the CR and PS groups, respectively (p = 0.29). The femorotibial angle averaged 5.85° ± 2.62° and 5.85° ± 3.27° valgus in the CR and PS groups, respectively (p = 0.60). The average tibial component angle was 0.46° ± 1.6° and 0.61° ± 1.3° varus in the CR and PS groups, respectively (p = 0.30); posterior inclination averaged 2.28° ± 2.36° and 1.93° ± 2.72° in the CR and PS groups, respectively (p = 0.51). Radiolucency was noted in 17 zones of the CR group and in 9 zones of the PS group (p = 0.24). Three TKAs required further surgery: one locking plate fixation for a periprosthetic tibial fracture (PS group) and two revision TKAs (one CR infection and one PS fracture). Conclusion Modular mini-keel tibial components showed good reliability and results with both CR and PS prostheses in minimally invasive surgery TKA.
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Affiliation(s)
- Cheng-Pang Yang
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and University College of Medicine, 5th, Fu-Shin Street, Kweishan Dist, Taoyuan, 333, Taiwan, Republic of China
| | - Kuo-Yao Hsu
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and University College of Medicine, 5th, Fu-Shin Street, Kweishan Dist, Taoyuan, 333, Taiwan, Republic of China
| | - Yu-Han Chang
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and University College of Medicine, 5th, Fu-Shin Street, Kweishan Dist, Taoyuan, 333, Taiwan, Republic of China
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and University College of Medicine, 5th, Fu-Shin Street, Kweishan Dist, Taoyuan, 333, Taiwan, Republic of China
| | - Hsin-Nung Shih
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and University College of Medicine, 5th, Fu-Shin Street, Kweishan Dist, Taoyuan, 333, Taiwan, Republic of China
| | - Alvin Chao-Yu Chen
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and University College of Medicine, 5th, Fu-Shin Street, Kweishan Dist, Taoyuan, 333, Taiwan, Republic of China.
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Li Z, Cheng W, Sun L, Yao Y, Cao Q, Ye S, Qi L, Xu S, Wu X, Jing J. Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study. INTERNATIONAL ORTHOPAEDICS 2017; 42:543-549. [PMID: 29199379 DOI: 10.1007/s00264-017-3703-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/21/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Whether minimally invasive total knee arthroplasty (MIS-TKA) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial. This prospective and randomized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA. METHODS Fifty patients, including 50 knees, who required TKA due to osteoarthritis were randomized to the mini-subvastus group (group I) or the medial parapatellar group (group II). All patients accepted the same method of anaesthesia, equal support therapy and identical rehabilitation exercise after surgery. The evaluation system included operation time, tourniquet time, blood loss, skin incision length in flexion, straight leg raising time, the time of lower limb muscle strength up to grade 4, the time of walking with aid or without aid, the time of walking up and down the stairs, the active flexion angle, range of movement (ROM), the Knee Society Scores (KSS), visual analogue score for pain (VAS), hospital stays and radiographic outcomes. RESULTS The mini-subvastus approach offered smaller skin incision length in flexion, but at the cost of operation time (P < 0.001). No significant difference was found in tourniquet time and blood loss. The patients in group I could achieve straight leg raising, the lower limb muscle strength up to grade 4, walking with or without aid, and walking up and down the stairs earlier (P < 0.001). The active flexion angle, ROM, VAS and KSS in group I were superior to those in group II until six months post-operatively (P < 0.001), but the differences was not apparent at 12 months post-operatively. More importantly, there was no significant difference between the two groups on radiological outcomes (P > 0.05). CONCLUSIONS The mini-subvastus approach could offer faster recovery, less pain and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the medial parapatellar approach.
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Affiliation(s)
- Ziyu Li
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Wendan Cheng
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Liangye Sun
- Department of Orthopaedic Surgery, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, China
| | - Yunfeng Yao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Qiliang Cao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Shuming Ye
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Lei Qi
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Shenglin Xu
- Department of Orthopaedic Surgery, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, China
| | - Xiaosan Wu
- Department of Orthopaedic Surgery, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, China
| | - Juehua Jing
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China.
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20
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Otero-López A, Beaton-Comulada D. Clinical Considerations for the Use Lower Extremity Arthroplasty in the Elderly. Phys Med Rehabil Clin N Am 2017; 28:795-810. [PMID: 29031344 DOI: 10.1016/j.pmr.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is an increase in the aging population that has led to a surge of reported cases of osteoarthritis and a greater demand for lower extremity arthroplasty. This article aims to review the current treatment options and expectations when considering lower extremity arthroplasty in the elderly patient with an emphasis on the following subjects: (1) updated clinical guidelines for the management of osteoarthritis in the lower extremity, (2) comorbidities and risk factors in the surgical patient, (3) preoperative evaluation and optimization of the surgical patient, (4) surgical approach and implant selection, and (5) rehabilitation and life after lower extremity arthroplasty.
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Affiliation(s)
- Antonio Otero-López
- Department of Orthopaedic Surgery, School of Medicine, University of Puerto Rico, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, USA.
| | - David Beaton-Comulada
- Department of Orthopaedic Surgery, School of Medicine, University of Puerto Rico, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR 00936-5067, USA
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Soft-tissue damage during total knee arthroplasty: Focus on tourniquet-induced metabolic and ionic muscle impairment. J Orthop 2017; 14:347-353. [PMID: 28706378 DOI: 10.1016/j.jor.2017.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/22/2017] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Advantages of tourniquet use in TKA include benefits for surgeons and patients, varying from a bloodless operation site to a reduced intervention time. The time under ischemia and the reperfusion period are crucial phases for affected soft-tissue, most commonly the extensor mechanism. CASE REPORTS documented its impact on soft-tissue, ranging from necrotic muscle damage to systemic inflammation. Recently, research regarding tourniquet application patterns discuss clinical outcome parameters in the context of soft-tissue damage, excluding the underlying pathophysiological mechanisms. METHODS This review summarizes the molecular aspects of soft-tissue damage occurring during tourniquet application in TKA with special focus on ischemia/reperfusion injury. Recent meta-analyses and original trials were reviewed for data on muscle damage and are presented. CONCLUSION Although underlying pathomechanisms are well known and presented, clinical orthopedic research has so far not addressed this issue. In context of physical training, positive effects regarding postoperative recovery might be possible if more attention is paid to prepare involved muscle preoperatively to TKA (prehabilitation).
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Feczko P, Engelmann L, Arts JJ, Campbell D. Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique: A prospective, randomized, international multicentre trial. BMC Musculoskelet Disord 2016; 17:19. [PMID: 26762175 PMCID: PMC4711101 DOI: 10.1186/s12891-016-0872-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/05/2016] [Indexed: 12/18/2022] Open
Abstract
Background Despite the growing evidence in the literature there is still a lack of consensus regarding the use of minimally invasive surgical technique (MIS) in total knee arthroplasty (TKA). Methods A prospective, randomized, international multicentre trial including 69 patients was performed to compare computer-assisted TKA (CAS-TKA) using either mini-midvastus (MIS group) or standard medial parapatellar approach (conventional group). Patients from 3 centers (Maastricht, Zwickau, Adelaide) with end-stage osteoarthritis of the knee were randomized to either an MIS group with dedicated instrumentation or a conventional group to receive cruciate retaining CAS-TKA without patella resurfacing. The primary outcome was to compare post operative pain and range of motion (ROM). The secondary outcome was to measure the duration of surgery, blood loss, chair rise test, quadriceps strength, anterior knee pain, Knee Society Score (KSS),WOMAC scores, mechanical leg axis and component alignment. Results Patients in the MIS group (3.97 ± 2.16) had significant more pain at 2 weeks than patients in the conventional group (2.77 ± 1.43) p = 0.003. There was no significant difference in any of the other primary outcome parameters. Surgery time was significantly longer (p < 0.001) and there were significantly higher blood loss (p = 0.002) in the MIS group as compared to the conventional group. The difference of the mean mechanical leg alignment between the groups was not statistically significant (–0.43° (95 % CI –1.50 – 0.64); p = 0.43). There was no significant difference of component alignment between the two surgical groups with respect to flexion/extension (p = 0.269), varus/valgus (p = 0.653) or rotational alignment (p = 0.485) of the femur component and varus valgus alignment (p = 0.778) or posterior slope (p = 0.164) of the tibial component. Conclusion There was no advantage of the MIS approach compared to a conventional approach CAS-TKA in any of the primary outcome measurements assessed, however the MIS approach was associated with longer surgical time and greater blood loss. MIS-TKA in combination with computer navigation is safe in terms of implant positioning. Trial registration number ClinicalTrials.gov NCT02625311 8 December 2015
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Affiliation(s)
- Peter Feczko
- Department Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Lutz Engelmann
- Heinrich-Braun-Krankenhaus Zwickau, Städtisches Klinikum, Zwickau, Germany
| | - Jacobus J Arts
- Department Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Koh IJ, Kim MW, Kim MS, Jang SW, Park DC, In Y. The Patient's Perception Does Not Differ Following Subvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Simultaneous Bilateral Randomized Study. J Arthroplasty 2016; 31:112-7. [PMID: 26350260 DOI: 10.1016/j.arth.2015.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/18/2015] [Accepted: 08/07/2015] [Indexed: 02/01/2023] Open
Abstract
This simultaneous bilateral randomized study investigated whether patients would perceive the difference between the subvastus approach (SVA) and the medial parapatellar approach (MPA) after total knee arthroplasty (TKA). In 50 patients scheduled to undergo same-day bilateral TKA, one knee was randomly assigned to SVA and the other to MPA. Patient-reported measures (pain, Western Ontario McMaster University Osteoarthritis Index score, and side preference) and physician-assessed measures (isokinetic muscle strength, range of motion, and Knee Society score) were compared. No differences were observed in the patient-reported measures and physician-assessed measures, with the exception of greater quadriceps strength at postoperative 1 week in knees that underwent SVA. Patients receiving contemporary perioperative management after same-day bilateral TKA do not perceive any difference between knees that underwent SVA or MPA.
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Affiliation(s)
- In Jun Koh
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Min Woo Kim
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, Seoul, Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, Seoul, Korea
| | - Sung Won Jang
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, Seoul, Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
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Peng X, Zhang X, Cheng T, Cheng M, Wang J. Comparison of the quadriceps-sparing and subvastus approaches versus the standard parapatellar approach in total knee arthroplasty: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2015; 16:327. [PMID: 26520065 PMCID: PMC4628282 DOI: 10.1186/s12891-015-0783-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/02/2015] [Indexed: 11/13/2022] Open
Abstract
Background The quadriceps-sparing and subvastus approaches are two of the most commonly used minimally-invasive approaches in total knee arthroplasty (TKA). However, the conclusion among studies still remains controversial. The purpose of this meta-analysis was to compare the clinical efficacy of the subvastus and quadriceps-sparing approaches with the standard parapatellar approach in TKA. Methods Randomized controlled trials (RCTs) comparing the quadriceps-sparing or subvastus approach with the standard parapatellar approach was identified in the databases of PubMed, the Cochrane library, EMBASE and Web of Science up to July 2014. Two authors extracted the following data: the basic characteristics of patients, the methodological quality and clinical outcomes from the included RCTs independently. RevMan 5.2.7 software was used for meta-analysis. Results A total of 19 RCTs (1578 patients) were included for meta-analysis. The results suggested that the quadriceps-sparing approach showed better outcomes in knee society score (KSS) and visual analog score (VAS), but this approach required a longer operative time than the standard parapatellar approach. There were no differences in total complications, wound infection, deep vein thrombosis, blood loss and hospital stay between the quadriceps-sparing and standard approaches. The subvastus approach showed better outcomes in VAS, knee range of motion (ROM), straight leg raise and lateral retinacular release than the standard parapatellar approach. There were no differences in KSS, total complication, wound infection, deep vein thrombosis, blood loss and hospital stay between the quadriceps-sparing and standard approaches. Conclusions The current evidence showed that, when compared with the standard parapatellar approach, the quadriceps-sparing approach was associated with better outcomes in KSS and VAS but required a longer operative time, and the subvastus approach was associated with better outcomes in VAS, ROM, straight leg raise and lateral retinacular release.
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Affiliation(s)
- Xiaochun Peng
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
| | - Xianlong Zhang
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
| | - Tao Cheng
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
| | - Mengqi Cheng
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
| | - Jiaxing Wang
- Department of Orthopaedics, The Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Yishan Road, Shanghai, 200233, China.
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25
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Huang AB, Wang HJ, Yu JK, Yang B, Ma D, Zhang JY. Optimal patellar alignment with minimally invasive approaches in total knee arthroplasty after a minimum five year follow-up. INTERNATIONAL ORTHOPAEDICS 2015; 40:487-92. [PMID: 26162985 DOI: 10.1007/s00264-015-2896-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 06/20/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Patellofemoral syndrome is still a common complication after total knee arthroplasty (TKA). However, the effects of specific surgical approaches on patellar tracking and alignment remain incompletely understood. In this study, we compared patellar alignment in patients who underwent TKA via three different techniques. METHODS A total of 96 patients who completed a minimum follow-up of five years were involved in three groups: 30 patients were treated with the traditional medial parapatellar approach (MPP group), 35 patients were treated with the mini-medial parapatellar approach (MMP group) and 31 were treated with a quadriceps-sparing approach (QS group). Radiographic data for patellar alignment and clinical results were compared. RESULTS Patellar tilt and patellar displacement at the final follow-up evaluation differed significantly among the three groups [P < 0.01, analysis of variance (ANOVA)]. The MMP and QS groups exhibited more proper patellar alignment than the MPP group. The clinical results did not differ significantly among the groups (P > 0.05, ANOVA). In addition, there were no correlations between postoperative patellar alignment and clinical scores. CONCLUSIONS The results of this study indicate that TKA performed using minimally invasive approaches yields superior patellar alignment compared to the traditional MPP approach.
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Affiliation(s)
- Ai-Bing Huang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Hai-Jun Wang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Jia-Kuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China.
| | - Bo Yang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Dong Ma
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
| | - Ji-Ying Zhang
- Institute of Sports Medicine, Peking University Third Hospital, No. 49, North Garden Road, Haidian District, Beijing, 100191, China
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Affiliation(s)
- Zachary D Post
- The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
| | - Carl Deirmengian
- The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
| | - Jess H Lonner
- The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
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Xu SZ, Lin XJ, Tong X, Wang XW. Minimally invasive midvastus versus standard parapatellar approach in total knee arthroplasty: a meta-analysis of randomized controlled trials. PLoS One 2014; 9:e95311. [PMID: 24845859 PMCID: PMC4028179 DOI: 10.1371/journal.pone.0095311] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/25/2014] [Indexed: 12/17/2022] Open
Abstract
Objective Minimally invasive midvastus approach (mini-midvastus) has been widely used in total knee arthroplasty (TKA). However, the clinical effects still remains controversial. This meta-analysis was based on randomized controlled trials (RCTs) aiming to quantitatively analyze the clinical efficacy of mini-midvastus versus standard parapatellar approach in TKA. Methods This meta-analysis was performed according to the PRISMA guidelines. A literature search for the eligible RCTs was carried out in the databases of PubMed, the Cochrane library, EMBASE and Web of Science. Two independent reviewers independently completed the study selection, data extraction, and the assessment of methodological quality. Meta-analysis was conducted by the RevMan 5.2 software. Results A total of 18 RCTs (937 patients with 1093 TKAs) published from 2007 to 2013 were included. The meta-analysis suggested that the mini-midvastus approach significantly improved knee range of motion (ROM) and decreased visual analog score (VAS) at postoperative 1–2 weeks (p<0.05), and there were no statistical differences in terms of knee society score (KSS) (6 weeks to 1 year), VAS (6 weeks to 6 months), ROM (6 weeks to 6 months), lateral retinacular release, blood loss, straight leg raise, hospital stay and postoperative complications between the mini-midvastus and standard parapatellar approach (p>0.05). However, the operative time was significantly longer when performing the mini-midvastus group than the parapartellar approach (p<0.05). Conclusion This meta-analysis found that compared with the standard parapatellar approach, the mini-midvastus approach had early advantages in the VAS and ROM, but had the disadvantage in the operative time. Level of Evidence Therapeutic study Level I.
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Affiliation(s)
- San-Zhong Xu
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China
| | - Xiang-Jin Lin
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China
- * E-mail:
| | - Xiang Tong
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China
| | - Xuan-Wei Wang
- Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China
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