Results of MIS TKA at Mean Nine Year Follow-Up

ABSTRACT

The first 103 consecutive minimally invasive total knee arthroplasties performed by a single surgeon were assessed to determine the clinical and radiographic outcomes at a mean of 9-year follow-up (range, 8 to 10 years). Patients who died before final follow-up were 10 (13 knees), leaving 90 knees in 69 patients for final review. Outcome was evaluated using Knee Society pain and functional scores. Survival with revision as an end point was 97.1%. Knee Society scores and range of motion improved significantly to a mean of 96 and 92 points and a mean of 115 degrees, respectively. There were five patients who required surgical intervention for unexplained pain with findings of retained cement and adhesions. Radiographic analysis did not reveal any progressive radiolucencies. These results suggest that excellent long-term outcomes can be achieved with minimally invasive total knee arthroplasty.

KEYWORDS

Minimally invasive - total knee arthroplasty - long-term outcome - survival

REFERENCES

• 1 Bonutti P M, Mont M A, McMahon M, Ragland P S, Kester M. Minimally invasive total knee arthroplasty.  J Bone Joint Surg Am. 2004;  86-A (Suppl 2) 26-32
• 2 Bonutti P M, Zywiel M G, Seyler T M 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
• 3 Haas S B, 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
• 4 Haas S B, Manitta M A, Burdick P. Minimally invasive total knee arthroplasty: the mini midvastus approach.  Clin Orthop Relat Res. 2006;  452 112-116
• 5 Laskin R S. Minimally invasive total knee replacement using a mini-mid vastus incision technique and results.  Surg Technol Int. 2004;  13 231-238
• 6 Laskin R S. Surgical exposure for total knee arthroplasty: for everything there is a season.  J Arthroplasty. 2007;  22 (4, Suppl 1) 12-14
• 7 Tsuji S, Tomita T, Fujii M, Laskin R S, 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
• 8 Huang H T, Su J Y, Chang J K, Chen C H, Wang G J. 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
• 9 Howe D J, Taunton Jr O D, Engh G A. Retained cement after unicondylar knee arthroplasty. A report of four cases.  J Bone Joint Surg Am. 2004;  86-A (10) 2283-2286
• 10 Chen A F, Alan R K, Redziniak D E, Tria Jr A J. Quadriceps sparing total knee replacement. The initial experience with results at two to four years.  J Bone Joint Surg Br. 2006;  88 (11) 1448-1453
• 11 Dalury D F, Dennis D A. Mini-incision total knee arthroplasty can increase risk of component malalignment.  Clin Orthop Relat Res. 2005;  440 77-81
• 12 Karpman R R, Smith H L. 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
• 13 Flören M, Reichel H, Davis J, Laskin R S. The mini-incision mid-vastus approach for total knee arthroplasty.  Oper Orthop Traumatol. 2008;  20 (6) 534-543
• 14 Tria Jr A J, Coon T M. Minimal incision total knee arthroplasty: early experience.  Clin Orthop Relat Res. 2003;  (416) 185-190
• 15 Kolisek F R, Bonutti P M, Hozack W J 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
• 16 Lonner J H. Minimally invasive approaches to total knee arthroplasty: results.  Am J Orthop. 2006;  35 (7, Suppl) 27-29
• 17 Tenholder M, Clarke H D, Scuderi G R. Minimal-incision total knee arthroplasty: the early clinical experience.  Clin Orthop Relat Res. 2005;  440 67-76
• 18 Laskin R S. Minimally invasive total knee arthroplasty: the results justify its use.  Clin Orthop Relat Res. 2005;  440 54-59
• 19 Wülker N, Lambermont J P, Sacchetti L, Lazaró J G, 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
• 20 Lozano L M, Núñez M, Segur J M et al.. Relationship between knee anthropometry and surgical time in total knee arthroplasty in severely and morbidly obese patients: a new prognostic index of surgical difficulty.  Obes Surg. 2008;  18 (9) 1149-1153
• 21 Lozano L M, Segur J M, Maculé F et al.. Intramedullary versus extramedullary tibial cutting guide in severely obese patients undergoing total knee replacement: a randomized study of 70 patients with body mass index >35 kg/m2.  Obes Surg. 2008;  18 (12) 1599-1604
• 22 Bonutti P M, Mont M A, Kester M A. Minimally invasive total knee arthroplasty: a 10-feature evolutionary approach.  Orthop Clin North Am. 2004;  35 (2) 217-226
• 23 King J, Stamper D L, Schaad D C, Leopold S S. Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty. Assessment of the learning curve and the postoperative recuperative period.  J Bone Joint Surg Am. 2007;  89 (7) 1497-1503
• 24 Lubowitz J H, Sahasrabudhe A, Appleby D. Minimally invasive surgery in total knee arthroplasty: the learning curve.  Orthopedics. 2007;  30 (8, Suppl) 80-82
• 25 Bonutti P M, Zywiel M G, Ulrich S D, McGrath M S, Mont M A. Minimally invasive total knee arthroplasty: pitfalls and complications.  Am J Orthop. 2010;  39 (10) 480-484
• 26 Varela-Egocheaga J R, Suárez-Suárez M A, Fernández-Villán M, González-Sastre V, Varela-Gómez J R, 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
• 27 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
• 28 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
• 29 Laskin R S, Beksac B, Phongjunakorn A et al.. Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study.  Clin Orthop Relat Res. 2004;  (428) 74-81
• 30 Niki Y, Matsumoto H, Otani T, Enomoto H, Toyama Y, Suda Y. Accuracy of implant positioning for minimally invasive total knee arthroplasty in patients with severe varus deformity.  J Arthroplasty. 2010;  25 (3) 381-386
• 31 Jackson G, Waldman B J, Schaftel E A. Complications following quadriceps-sparing total knee arthroplasty.  Orthopedics. 2008;  31 (6) 547
• 32 Bonutti P M, Seyler T M, Kester M, McMahon M, Mont M A. Minimally invasive revision total knee arthroplasty.  Clin Orthop Relat Res. 2006;  446 69-75
• 33 Tria Jr A J. Minimally invasive total knee arthroplasty: the importance of instrumentation.  Orthop Clin North Am. 2004;  35 (2) 227-234
• 34 Seyler T M, Johnson A J, Marker D R, Mont M A, Bonutti P M. Arthroscopic-assisted minimally invasive total knee arthroplasty.  Arthroscopy. 2011;  27 (2) 290-293