Better outcomes after minimally invasive surgeries compared to the standard invasive medial parapatellar approach for to
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KNEE
Better outcomes after minimally invasive surgeries compared to the standard invasive medial parapatellar approach for total knee arthroplasty: a meta‑analysis Filippo Migliorini1 · Jörg Eschweiler1 · Alice Baroncini1 · Markus Tingart1 · Nicola Maffulli2,3,4 Received: 12 June 2020 / Accepted: 24 September 2020 © The Author(s) 2020
Abstract Purpose Minimally invasive surgery (MIS) for total knee arthroplasty (TKA) is often marketed as being able to speed up healing times over standard invasive surgery (SIS) through the medial parapatellar approach. The advantages of these minimally invasive approaches, however, are not yet definitively established. A meta-analysis of studies comparing peri-operative and post-operative differences and long-term complications of MIS versus SIS for TKA was conducted. Methods This meta-analysis was conducted following the PRISMA guidelines. The Pubmed, Google Scholar, Scopus, and Embase databases were accessed in September 2020. All clinical trials comparing minimally-invasive versus standard approaches for TKA were considered. Only studies reporting quantitative data under the outcomes of interest were included. Methodological quality assessment was performed using the PEDro appraisal score. Results This meta-analysis covers a total of 38 studies (3296 procedures), with a mean 21.3 ± 24.3 months of follow-up. The MIS group had shorter hospitalization times, lower values of total estimated blood loss, quicker times of straight-leg raise, greater values for range of motion, higher scores on the Knee Society Clinical Rating System (KSS) and its related Function Subscale (KSFS). Pain scores, anterior knee pain and revision rate were similar between MIS and SIS. SIS allowed a quicker surgical duration. Conclusion The present meta-analysis encourages the use of minimally invasive techniques for total knee arthroplasty. However, MIS TKA is technically demanding and requires a long learning curve. Level of evidence III, meta-analysis of clinical trials. Keywords Total knee arthroplasty · Minimally invasive surgery · Standard invasive surgery
Introduction
* Filippo Migliorini [email protected] 1
Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany
2
Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy
3
Barts and The London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, England
4
School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England
The most common exposure for total knee arthroplasty (TKA) is the medial parapatellar arthrotomy (MPP) using standard incision surgery (SIS) [22]. Despite the satisfying surgical outcomes, this approach has been criticized as it produces extensive damage to the knee extensor muscle mechanism, and it may negatively affe
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