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Comparisons between mini-midvastus (mMV) and mini-medial parapatellar approach (mMPP) for total knee arthroplasty (TKA) have reported variable results. We compared two approaches with minimum two year follow up. Forty consecutive patients who underwent staged bilateral TKA were prospectively randomized for mMPP approach in one knee and mMV approach in the other. Clinical parameters (muscle strength, pain, ROM, Knee Society Score) and surgic.l parameters (duration of surgery, blood loss, lateral releases) were assessed at 2, 6, 12 weeks and 6, 12, 24 months postoperatively. Clinical outcomes revealed inconsistent pattern of differences at various intervals. Surgical outcomes were not different. There were no major differences in outcomes between the two approaches. We recommend someone use surgical approach with which they are most familiar.

We sought to determine the incidence of bicompartmental osteoarthritis among knee replacement patients for possible bone-sparing procedures. In 259 consecutive Knee Registry subjects undergoing total or unicondylar knee arthroplasty, all three compartments of the knee joint were evaluated. Radiographic images and preoperative cruciate ligaments assessment combined with intraoperative cartilage grading using Outerbridge classification was implemented for patients' evaluations. Among the candidates for knee replacement arthroplasty, 59% had osteoarthritis in all three compartments, 28% had bicompartmental disease, and 4% had unicompartmental disease. Nine percent of patients exhibited inconclusive osteoarthritis pattern. Only 5% of the patients were found to have cruciate ligaments impairment. Older patients ( > 65 years) were significantly more likely to have bi- and tricompartmental disease. We had found that 28% of our registry population had bicompartmental disease and infrequent impairment of cruciate ligaments, indicating that between one-fourth and one-third of patients undergoing total knee arthroplasty could be considered for bone preserving bicompartmental knee arthroplasty.

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