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DOI: 10.1055/s-0032-1327449
Minimally Invasive Total Knee Arthroplasty: Surgical Implications for Recovery
Publication History
24 May 2012
22 July 2012
Publication Date:
12 November 2012 (online)
Abstract
Background Despite growing interest in minimally invasive surgery (MIS) techniques for total knee arthroplasty (TKA), few randomized controlled trials have compared MIS and conventional TKA using a combination of functional performance, knee pain, knee range of motion (ROM), and surgical and radiographic outcomes.
Methods A prospective, randomized investigation comparing early outcomes of TKA using conventional or MIS approaches (n = 44). Patients were assessed preoperatively, 48 hours, 4 and 12 weeks postoperatively by blinded evaluators. Outcome measures included timed-up-and-go, 100-ft walk, knee pain, passive knee ROM, Knee Society Score, blood loss, tourniquet time, hospital length of stay, surgical complications, and radiographic outcomes.
Results No significant differences in functional performance, knee pain, knee ROM, surgical, or radiographic outcomes were observed between groups at 48 hours, 4 or 12 weeks postoperatively.
Conclusion While surgical and radiographic outcomes were not compromised with MIS surgery, there were also no improvements in pain, ROM, or functional performance with MIS TKA.
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References
- 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (4) 780-785
- 2 Bonutti PM, Mont MA, Kester MA. Minimally invasive total knee arthroplasty: a 10-feature evolutionary approach. Orthop Clin North Am 2004; 35 (2) 217-226
- 3 Khanna A, Gougoulias N, Longo UG, Maffulli N. Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin North Am 2009; 40 (4) 479-489 , viii
- 4 Cheng T, Liu T, Zhang G, Peng X, Zhang X. Does minimally invasive surgery improve short-term recovery in total knee arthroplasty?. Clin Orthop Relat Res 2010; 468 (6) 1635-1648
- 5 Bonutti PM, Zywiel MG, McGrath MS, Mont MA. Surgical techniques for minimally invasive exposures for total knee arthroplasty. Instr Course Lect 2010; 59: 83-91
- 6 Pagnano MW, Krych AJ. Primary total knee arthroplasty: less invasive approaches. In: Berry D, , ed. Primary Total Knee Arthroplasty. Rosemont, IL: The American Academy of Orthopaedic Surgeons; 2001: 3-9
- 7 Bonutti PM, Mont MA, McMahon M, Ragland PS, Kester M. Minimally invasive total knee arthroplasty. J Bone Joint Surg Am 2004; 86-A (Suppl. 02) 26-32
- 8 Haas SB, Cook S, Beksac B. Minimally invasive total knee replacement through a mini midvastus approach: a comparative study. Clin Orthop Relat Res 2004; (428) 68-73
- 9 Vail TP. Minimally invasive knee arthroplasty. Clin Orthop Relat Res 2004; (428) 51-52
- 10 Karpman RR, Smith HL. Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty: a prospective, randomized study. J Arthroplasty 2009; 24 (5) 681-688
- 11 Kim JG, Lee SW, Ha JK, Choi HJ, Yang SJ, Lee MY. The effectiveness of minimally invasive total knee arthroplasty to preserve quadriceps strength: a randomized controlled trial. Knee 2011; 18 (6) 443-447
- 12 Smith TO, King JJ, Hing CB. A meta-analysis of randomised controlled trials comparing the clinical and radiological outcomes following minimally invasive to conventional exposure for total knee arthroplasty. Knee 2012; 19 (1) 1-7
- 13 Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamoto Y. Minimally invasive versus standard approach in total knee arthroplasty. Clin Orthop Relat Res 2007; 463: 114-150
- 14 Varnell MS, Bhowmik-Stoker M, McCamley J, Jacofsky MC, Campbell M, Jacofsky D. Difference in stair negotiation ability based on TKA surgical approach. J Knee Surg 2011; 24 (2) 117-123
- 15 Incavo SJ, Dayton MR, Exaltacion JJF. Primary total knee arthroplasty: medial parapatellar approach. In: Berry D, , ed. Primary Total Knee Arthroplasty. Rosemont, IL: The American Academy of Orthopaedic Surgeons; 2011: 3-9
- 16 Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 2010; 40 (9) 559-567
- 17 Stevens JE, Mizner RL, Snyder-Mackler L. Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res 2003; 21 (5) 775-779
- 18 Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am 2005; 87 (5) 1047-1053
- 19 Pagnano MW, Meneghini RM, Trousdale RT. Anatomy of the extensor mechanism in reference to quadriceps-sparing TKA. Clin Orthop Relat Res 2006; 452: 102-105
- 20 Mizner RL, Stevens JE, Snyder-Mackler L. Voluntary activation and decreased force production of the quadriceps femoris muscle after total knee arthroplasty. Phys Ther 2003; 83 (4) 359-365
- 21 Bezwada HP, Booth RE. Soft tissue balancing technique for posterior stabilized total knee arthroplasty. In: Lotke PA, Lonner JH, , eds. Master Techniques in Orthopaedic Surgery: Knee Arthroplasty. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2009: 83-99
- 22 Stevens-Lapsley JE, Bade MJ, Shulman BC, Kohrt WM, Dayton MR. Minimally Invasive Total Knee Arthroplasty Improves Early Knee Strength But Not Functional Performance: A Randomized Controlled Trial. J Arthroplasty 2012; (Epub ahead of print)
- 23 Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther 2012; 92 (2) 210-226
- 24 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39 (2) 142-148
- 25 Enloe LJ, Shields RK, Smith K, Leo K, Miller B. Total hip and knee replacement treatment programs: a report using consensus. J Orthop Sports Phys Ther 1996; 23 (1) 3-11
- 26 Ilfeld BM, Gearen PF, Enneking FK , et al. Total knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: a prospective feasibility study. Anesth Analg 2006; 102 (1) 87-90
- 27 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
- 28 Norkin CC, White DJ , eds. Measurement of Joint Motion: A Guide to Goniometry. 3rd ed. Philadelphia: F. A. Davis Company; 2003
- 29 Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989; (248) 9-12
- 30 Smith TO, King JJ, Hing CB. A meta-analysis of randomised controlled trials comparing the clinical and radiological outcomes following minimally invasive to conventional exposure for total knee arthroplasty. Knee 2012; 19 (1) 1-7
- 31 Stevens-Lapsley JE, Schenkman ML, Dayton MR. Comparison of self-reported knee injury and osteoarthritis outcome score to performance measures in patients after total knee arthroplasty. PM R 2011; 3 (6) 541-549 , quiz 549
- 32 Mizner RL, Petterson SC, Clements KE, Zeni Jr JA, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty 2011; 26 (5) 728-737
- 33 Bonutti PM, Costa CR, Woehnl A, Johnson AJ, Mont MA. Results of MIS TKA at mean nine year follow-up. J Knee Surg 2011; 24 (3) 203-207
- 34 Huang HT, Su JY, Chang JK, Chen CH, Wang GJ. The early clinical outcome of minimally invasive quadriceps-sparing total knee arthroplasty: report of a 2-year follow-up. J Arthroplasty 2007; 22 (7) 1007-1012
- 35 Tai TW, Lin CJ, Jou IM, Chang CW, Lai KA, Yang CY. Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2011; 19 (7) 1121-1130
- 36 Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 2011; 93 (17) 1588-1596
- 37 Pan WM, Li XG, Tang TS, Qian ZL, Zhang Q, Zhang CM. Mini-subvastus versus a standard approach in total knee arthroplasty: a prospective, randomized, controlled study. J Int Med Res 2010; 38 (3) 890-900
- 38 Dalury DF, Dennis DA. Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res 2005; 440: 77-81