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
