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Web End = Knee Surg Sports Traumatol Arthrosc (2015) 23:19711985 DOI 10.1007/s00167-014-2837-4
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Web End = A meta-analysis of minimally invasive and conventional medial parapatella approaches for primary total knee arthroplasty
Canfeng Li Yi Zeng Bin Shen Pengde Kang
Jing Yang Zongke Zhou Fuxing Pei
Received: 23 July 2013 / Accepted: 8 January 2014 / Published online: 22 January 2014 Springer-Verlag Berlin Heidelberg 2014
AbstractPurpose Minimally invasive surgical (MIS) approaches for total knee arthroplasty (TKA) have become increasingly popular for doctors and patients. They have argued that it decreases post-operative pain, accelerates functional recovery and increases patient satisfaction due to less injury. However, critics are concerned about TKAs possible effects on component position and with complications, considering the procedures limited exposure. The purpose of this study was to summarise the best evidence in comparing the clinical and radiological outcomes between MIS and a conventional approach in TKA.
Methods Electronic databases were systematically searched to identify relevant randomised controlled trials (RCTs). Our search strategy followed the requirements of the Cochrane Library Handbook. Methodological quality was assessed, and data were extracted independently by two authors.
Results Thirty studies, including 2,536 TKAs, were reviewed: 1,259 minimally invasive and 1,277 conventional exposure TKAs. The results showed that while the MIS group had longer operation times and tourniquet times, it had superior outcomes in KSS (objective and total), range of motion, exion range of motion, exion 90
day, straight leg-raising day, total blood loss and decrease in haemoglobin. However, wound-healing problems occurred more frequently in the MIS group. There were no statistically signicant differences in other clinical or
radiological outcomes between the MIS and conventional groups in TKA.
Conclusion The preliminary results indicate that the MIS approach provides an alternative to the conventional approach, with earlier rehabilitation but no malpositioning or severe complications. Wound-healing problems can be treated easily and effectively, and the risk also decreases as surgeons become more experienced, and more user-friendly instruments are invented. Potential benets in medium- and long-term outcomes require larger, multi-centre and well-conducted RCTs to conrm.
Level of evidence Therapeutic...