Download PDF
J Knee Surg 2013; 26(01): 041-050
DOI: 10.1055/s-0032-1313751
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Critical Review of Minimally Invasive Approaches in Knee Arthroplasty

Christopher R. Costa
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Aaron J. Johnson
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Steven F. Harwin
2   The Center for Reconstructive Joint Surgery, Beth Israel Medical Center, New York, New York
,
Michael A. Mont
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Peter M. Bonutti
3   Bonutti Clinic, Effingham, Illinois
› Author Affiliations
Further Information

Publication History

31 May 2011

28 December 2011

Publication Date:
15 May 2012 (online)

   Permissions and Reprints

Abstract

Despite high survivorship for total knee arthroplasty, many reports have described low patient-satisfaction rates. Standard parapatellar approaches have been linked with decreased quadriceps muscle strength, which may in turn lead to prolonged rehabilitation and altered kinematics. Although technically demanding, minimally invasive techniques offer the potential for shorter recovery times and improved strength. Our purpose was to compare perioperative factors, the clinical and radiographic outcomes, complications, and survivorship of several minimally invasive approaches to each other and to the conventional medial parapatellar approach. A total of 23 level I or II studies were reviewed. There were no statistically significant differences in perioperative factors, clinical or radiographic outcomes, survivorship, or complication rates between patients the various minimally invasive approaches to a standard approach. The only significant difference observed was in recovery of quadriceps muscle function (shorter in patients who had a minimally invasive approach). The minimally invasive lateral approach had more complications than the other minimally invasive approaches. The mini-midvastus approach had the best clinical outcomes at 1 and 3 months when compared with other minimally invasive approaches and standard approaches. The mini-subvastus approach had the lowest rate of complications, overall. Further multicenter randomized trials are needed to determine the minimally invasive approach that best improves outcomes while minimizing complications.

Keywords

minimally invasive - total knee arthroplasty - review - mini-incision
 

  • References

  • 1 Kelly MA, Clarke HD. Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop Relat Res 2002; (404) 51-57
    PubMedSearch in Google Scholar
  • 2 Labek G, Thaler M, Janda W, Agreiter M, Stöckl B. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br 2011; 93 (3) 293-297
    CrossrefPubMedSearch in Google Scholar
  • 3 Goodfellow JW, O'Connor JJ, Murray DW. A critique of revision rate as an outcome measure: re-interpretation of knee joint registry data. J Bone Joint Surg Br 2010; 92 (12) 1628-1631
    CrossrefPubMedSearch in Google Scholar
  • 4 Insall J. A midline approach to the knee. J Bone Joint Surg Am 1971; 53 (8) 1584-1586
    CrossrefPubMedSearch in Google Scholar
  • 5 Suda AJ, Seeger JB, Bitsch RG, Krueger M, Clarius M. Are patients' expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics 2010; 33 (2) 76-80
    PubMedSearch in Google Scholar
  • 6 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (1) 57-63
    CrossrefPubMedSearch in Google Scholar
  • 7 Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: is it really an effective procedure for all?. Knee 2007; 14 (6) 417-423
    CrossrefPubMedSearch in Google Scholar
  • 8 Dickstein R, Heffes Y, Shabtai EI, Markowitz E. Total knee arthroplasty in the elderly: patients' self-appraisal 6 and 12 months postoperatively. Gerontology 1998; 44 (4) 204-210
    CrossrefPubMedSearch in Google Scholar
  • 9 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
    CrossrefPubMedSearch in Google Scholar
  • 10 Silva M, Shepherd EF, Jackson WO, Pratt JA, McClung CD, Schmalzried TP. Knee strength after total knee arthroplasty. J Arthroplasty 2003; 18 (5) 605-611
    CrossrefPubMedSearch in Google Scholar
  • 11 Noble PC, Gordon MJ, Weiss JM, Reddix RN, Conditt MA, Mathis KB. Does total knee replacement restore normal knee function?. Clin Orthop Relat Res 2005; (431) 157-165
    PubMedSearch in Google Scholar
  • 12 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
    PubMedSearch in Google Scholar
  • 13 Bonutti PM, Neal DJ, Kester MA. Minimal incision total knee arthroplasty using the suspended leg technique. Orthopedics 2003; 26 (9) 899-903
    PubMedSearch in Google Scholar
  • 14 Howick J, Chalmers I, Glasziou P , et al. The Oxford 2011 Levels of Evidence. Available at: http://www.cebm.net/index.aspx?o=5653 . Accessed April 19, 2011
    PubMed
  • 15 Tria Jr AJ, Coon TM. Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 2003; (416) 185-190
    PubMedSearch in Google Scholar
  • 16 Schroer WC, Diesfeld PJ, Reedy ME, LeMarr AR. Mini-subvastus approach for total knee arthroplasty. J Arthroplasty 2008; 23 (1) 19-25
    CrossrefPubMedSearch in Google Scholar
  • 17 Lüring C, Beckmann J, Haiböck P, Perlick L, Grifka J, Tingart M. Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial. Knee Surg Sports Traumatol Arthrosc 2008; 16 (10) 928-934
    CrossrefPubMedSearch in Google Scholar
  • 18 Keblish PA. The lateral approach to the valgus knee. Surgical technique and analysis of 53 cases with over two-year follow-up evaluation. Clin Orthop Relat Res 1991; (271) 52-62
    PubMedSearch in Google Scholar
  • 19 Buechel FF. A sequential three-step lateral release for correcting fixed valgus knee deformities during total knee arthroplasty. Clin Orthop Relat Res 1990; (260) 170-175
    PubMedSearch in Google Scholar
  • 20 Aglietti P, Baldini A, Sensi L. Quadriceps-sparing versus mini-subvastus approach in total knee arthroplasty. Clin Orthop Relat Res 2006; 452: 106-111
    CrossrefPubMedSearch in Google Scholar
  • 21 Boerger TO, Aglietti P, Mondanelli N, Sensi L. Mini-subvastus versus medial parapatellar approach in total knee arthroplasty. Clin Orthop Relat Res 2005; 440: 82-87
    CrossrefPubMedSearch in Google Scholar
  • 22 Bonutti PM, Zywiel MG, Seyler TM , et al. Minimally invasive total knee arthroplasty using the contralateral knee as a control group: a case-control study. Int Orthop 2010; 34 (4) 491-495
    CrossrefPubMedSearch in Google Scholar
  • 23 Chin PL, Foo LS, Yang KY, Yeo SJ, Lo NN. Randomized controlled trial comparing the radiologic outcomes of conventional and minimally invasive techniques for total knee arthroplasty. J Arthroplasty 2007; 22 (6) 800-806
    CrossrefPubMedSearch in Google Scholar
  • 24 Han I, Seong SC, Lee S, Yoo JH, Lee MC. Simultaneous bilateral MIS-TKA results in faster functional recovery. Clin Orthop Relat Res 2008; 466 (6) 1449-1453
    CrossrefPubMedSearch in Google Scholar
  • 25 Hernandez-Vaquero D, Noriega-Fernandez A, Suarez-Vazquez A. Total knee arthroplasties performed with a mini-incision or a standard incision. Similar results at six months follow-up. BMC Musculoskelet Disord 2010; 11: 27
    CrossrefPubMedSearch in Google Scholar
  • 26 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
    CrossrefPubMedSearch in Google Scholar
  • 27 Karachalios T, Giotikas D, Roidis N, Poultsides L, Bargiotas K, Malizos KN. Total knee replacement performed with either a mini-midvastus or a standard approach: a prospective randomised clinical and radiological trial. J Bone Joint Surg Br 2008; 90 (5) 584-591
    CrossrefPubMedSearch in Google Scholar
  • 28 Kolisek FR, Bonutti PM, Hozack WJ , et al. Clinical experience using a minimally invasive surgical approach for total knee arthroplasty: early results of a prospective randomized study compared to a standard approach. J Arthroplasty 2007; 22 (1) 8-13
    PubMedSearch in Google Scholar
  • 29 Lin WP, Lin J, Horng LC, Chang SM, Jiang CC. Quadriceps-sparing, minimal-incision total knee arthroplasty: a comparative study. J Arthroplasty 2009; 24 (7) 1024-1032
    CrossrefPubMedSearch in Google Scholar
  • 30 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
    CrossrefPubMedSearch in Google Scholar
  • 31 Varela-Egocheaga JR, Suárez-Suárez MA, Fernández-Villán M, González-Sastre V, Varela-Gómez JR, Rodríguez-Merchán C. Minimally invasive subvastus approach: improving the results of total knee arthroplasty: a prospective, randomized trial. Clin Orthop Relat Res 2010; 468 (5) 1200-1208
    CrossrefPubMedSearch in Google Scholar
  • 32 Bridgman SA, Walley G, MacKenzie G, Clement D, Griffiths D, Maffulli N. Sub-vastus approach is more effective than a medial parapatellar approach in primary total knee arthroplasty: a randomized controlled trial. Knee 2009; 16 (3) 216-222
    CrossrefPubMedSearch in Google Scholar
  • 33 Juosponis R, Tarasevicius S, Smailys A, Kalesinskas RJ. Functional and radiological outcome after total knee replacement performed with mini-midvastus or conventional arthrotomy: controlled randomised trial. Int Orthop 2009; 33 (5) 1233-1237
    CrossrefPubMedSearch in Google Scholar
  • 34 Kashyap SN, van Ommeren JW. Clinical experience with less invasive surgery techniques in total knee arthroplasty: a comparative study. Knee Surg Sports Traumatol Arthrosc 2008; 16 (6) 544-548
    CrossrefPubMedSearch in Google Scholar
  • 35 Kim YH, Kim JS, Kim DY. Clinical outcome and rate of complications after primary total knee replacement performed with quadriceps-sparing or standard arthrotomy. J Bone Joint Surg Br 2007; 89 (4) 467-470
    CrossrefPubMedSearch in Google Scholar
  • 36 Tsuji S, Tomita T, Fujii M, Laskin RS, Yoshikawa H, Sugamoto K. Is minimally invasive surgery-total knee arthroplasty truly less invasive than standard total knee arthroplasty? A quantitative evaluation. J Arthroplasty 2010; 25 (6) 970-976
    CrossrefPubMedSearch in Google Scholar
  • 37 Chotanaphuti T, Ongnamthip P, Karnchanalerk K, Udombuathong P. Comparative study between 2 cm limited quadriceps exposure minimal invasive surgery and conventional total knee arthroplasty in quadriceps function: prospective randomized controlled trial. J Med Assoc Thai 2008; 91 (2) 203-207
    PubMedSearch in Google Scholar
  • 38 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
    CrossrefPubMedSearch in Google Scholar
  • 39 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: 144-150
    PubMedSearch in Google Scholar
  • 40 Niki Y, Matsumoto H, Hakozaki A, Kanagawa H, Toyama Y, Suda Y. Clinical and radiographic outcomes of minimally invasive total knee arthroplasty through a lateral approach. Knee Surg Sports Traumatol Arthrosc 2011; 19 (6) 973-979
    CrossrefPubMedSearch in Google Scholar
  • 41 Lombardi Jr AV, Berend KR, Adams JB. Minimally Invasive Surgery Is Not a Risk Factor of Early Total Knee Arthroplasty Failure. Semin Arthroplasty 2010; 21 (2) 92-96
    CrossrefPubMedSearch in Google Scholar
  • 42 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
    CrossrefPubMedSearch in Google Scholar
  • 43 Bonutti PM, Zywiel MG, Ulrich SD, Stroh DA, Seyler TM, Mont MA. A comparison of subvastus and midvastus approaches in minimally invasive total knee arthroplasty. J Bone Joint Surg Am 2010; 92 (3) 575-582
    CrossrefPubMedSearch in Google Scholar
  • 44 Walter F, Haynes MB, Markel DC. A randomized prospective study evaluating the effect of patellar eversion on the early functional outcomes in primary total knee arthroplasty. J Arthroplasty 2007; 22 (4) 509-514
    CrossrefPubMedSearch in Google Scholar
  • 45 Dalury DF, Mulliken BD, Adams MJ, Lewis C, Sauder RR, Bushey JA. Early recovery after total knee arthroplasty performed with and without patellar eversion and tibial translation. A prospective randomized study. J Bone Joint Surg Am 2009; 91 (6) 1339-1343
    CrossrefPubMedSearch in Google Scholar
  • 46 Gandhi R, Smith H, Lefaivre KA, Davey JR, Mahomed NN. Complications after minimally invasive total knee arthroplasty as compared with traditional incision techniques: a meta-analysis. J Arthroplasty 2011; 26 (1) 29-35
    CrossrefPubMedSearch in Google Scholar
  • 47 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
    CrossrefPubMedSearch in Google Scholar
  • 48 Seyler TM, Bonutti PM, Ulrich SD, Fatscher T, Marker DR, Mont MA. Minimally invasive lateral approach to total knee arthroplasty. J Arthroplasty 2007; 22 (7, Suppl 3) 21-26
    PubMedSearch in Google Scholar
  • 49 Mont MA, Zywiel MG, McGrath MS, Bonutti PM. Scientific evidence for minimally invasive total knee arthroplasty. Instr Course Lect 2010; 59: 73-82
    PubMedSearch in Google Scholar
  • 50 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
    CrossrefPubMedSearch in Google Scholar
  • 51 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
    CrossrefPubMedSearch in Google Scholar
  • 52 Martin A, Sheinkop MB, Langhenry MM, Widemschek M, Benesch T, von Strempel A. Comparison of two minimally invasive implantation instrument-sets for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010; 18 (3) 359-366
    CrossrefPubMedSearch in Google Scholar
  • 53 Wülker N, Lambermont JP, Sacchetti L, Lazaró JG, Nardi J. A prospective randomized study of minimally invasive total knee arthroplasty compared with conventional surgery. J Bone Joint Surg Am 2010; 92 (7) 1584-1590
    CrossrefPubMedSearch in Google Scholar
  • 54 Kim YH, Sohn KS, Kim JS. Short-term results of primary total knee arthroplasties performed with a mini-incision or a standard incision. J Arthroplasty 2006; 21 (5) 712-718
    CrossrefPubMedSearch in Google Scholar