Less invasive versus standard total knee replacement: Comparison of early outcome.

ABSTRACT

OBJECTIVE: To compare less invasive quads conserving (limited parapatellar) approach with standard medial parapatellar approach with respect to early functional outcome in cases of total knee arthroplasty. METHODS: The retrospective case-control cohort study comprised cases operated upon between June 2009 and March 2012 in Combined Military Hospitals in Pakistan by a single surgeon. Data related to osteoarthritis patients who underwent unilateral primary total knee replacement were included. They were divided into two equal groups of control who had standard total knee arthroplasty, and the test group where less invasive surgery method was employed. Patients were followed up for 3 months postoperatively. The outcomes recorded included mean hospital stay, time to assisted ambulation, time to independent ambulation, mean range of motion and Knee Society Scores [KSS] 1 and 3 months postoperatively. RESULTS: There were 120 subjects with 60(50%) in each of the two groups. Mean hospital stay was 3.2±0.6 days for the test group compared to 5.8±1.6 days for the control group. Most test group patients were walking with assistance on 2nd postoperative day (mean 1.7±0.6 days), whereas control group on the 4th day (mean 4.1±1.1 days). Independent ambulation was seen at 2.1±0.3 weeks and 4.0±0.7weeks respectively in the two groups. Postoperative range of motion at 1 month was 118±13 for patients in the test group, and 99±13 for control group, with Knee Society Scores of 87±6 and 72±9 respectively. The difference in all results was statistically significant (p<0.05). CONCLUSIONS: Less invasive surgery for total knee arthroplasty was associated with faster recovery, earlier assisted and independent ambulation, shorter lengths of hospitalisation and better Knee Society Scores at 1and 3months postoperatively.