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

Abstract

Patients desire less pain and faster recovery of range of knee motion after total knee arthroplasty (TKA). While minimal invasive surgery (MIS) TKA appears to meet these needs, concerns exist regarding component malpositioning. Navigation systems can reduce the incidence of component misalignment. The present prospective randomized study compared limited medial parapatellar (LMPP) and mini-midvastus (MMV) approaches in 30 patients who had bilateral simultaneous primary TKAs. Each patient underwent LMPP on one knee and MMV on the other. Both approaches were navigation-assisted. We primarily analyzed postoperative pain (using visual analog scores), range of knee motion, and hospital for special surgery (HSS) scores in the first 6 postoperative months (i.e., the early postoperative period), and secondarily analyzed perioperative parameters and radiographic outcomes. The LMPP and MMV approaches were found to be similar in terms of pain measured at postoperative 3 days, 1, 2 weeks, 1, 3, and 6 months (P = NS). Similarly, the 2 approaches were found to be similar in terms of range of motion measured at 1, 2 weeks, 1, 3, and 6 months (P = NS), and in terms of HSS scores measured at 1, 3, and 6 months (P = NS). There were also no differences between groups in terms of total blood loss, approach preferred by patients, and radiographic component positioning. The present study found that navigation-assisted MMV and navigation-assisted LMPP resulted in similar outcomes in terms of pain, ROM, HSS score, and radiologic outcomes over the first six postoperative months. We recommend the LMPP approach over the MMV approach in navigation-assisted MIS TKA because it is more familiar to surgeons and is easier to convert to the conventional approach where necessary.

A prospective randomised study of minimally invasive midvastus total knee arthroplasty compared with standard total knee arthroplasty

“…However an RCT comparing MIS to standard approach in obese patients did show earlier improvement in clinical outcomes and no compromise of component position in the MIS group [45]. At a time when concerns regarding surgical training are prescient, the MMV approach may have advantage due to the ease with which it may be adopted by surgeons familiar with the standard MPP approach and indeed can be extended into a standard approach if needed [46]. It is increasingly recognised that there is a significant learning curve for certain minimally invasive approaches [8] and that this may be of relevance to the low volume surgeon [23].…”

Minimally Invasive Midvastus versus Standard Parapatellar Approach in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

“…Five studies were included for meta-analysis of VAS [12], [22]–[24], [27]. Subgroup analyses suggested that the mini-midvastus approach significantly decreased VAS at postoperative 2 weeks ( p <0.01), and no differences were seen between the two groups at the time points of 3 day ( p  = 0.42), 6 week ( p  = 0.22), 3 month ( p  = 0.82), 6 month ( p  = 0.80).…”

Faster recovery after minimally invasive surgery in total knee arthroplasty

“…No significant difference in length of stay or analgesia intake was observed when comparing these different muscular approaches [19]. Many of these studies were focusing on the mini-midvastus approach [3,10,16,21]. Maybe this transmuscular approach is not so innocent as sometimes inferior quadriceps function [29], or higher muscle enzymes were observed in mini-midvastus and mini-subvastus approaches through stretching or cutting of the muscle [22,29].…”

“…In our experience, the minimally invasive medial parapatellar approach may be the easiest approach to convert from the classic approach [16].…”

“…However, better short-term recovery leading to early failure is not acceptable for an intervention that has excellent results since many decades [2,6]. Most of the MIS studies compared different proximal approaches (mini-midvastus, mini-subvastus and the limited parapatellar approach) with conventional techniques [3,11,16,21,28].…”