Midvastus Versus Medial Parapatellar Approach in Simultaneous Bilateral Total Knee Arthroplasty.

BACKGROUND: The purpose of this study was to compare the postoperative outcomes over a period of 3 years in patients who underwent bilateral total knee arthroplasty (TKA) using midvastus (MV) versus medial parapatellar (MPP) approaches. METHODS: In this retrospective study, 2 propensity-matched cohorts of patients who underwent simultaneous bilateral TKA via MV (n = 100) and MPP (n = 100) approaches from January 2017 to December 2018 were compared. Surgical parameters compared were surgery time and the incidence of lateral retinacular release (LRR). Clinical parameters including the visual analog score for pain, time for straight leg raise (SLR), range of motion, the Knee Society Score, and the Feller patellar score were assessed in the early postoperative and follow-up periods up to 3 years. Radiographs were evaluated for alignment, patellar tilt, and displacement. RESULTS: LRR was performed on 17 knees (8.5%) in the MPP group and 4 knees (2%) in the MV group which was significant (P = .03). The time to SLR was significantly lower in the MV group. There was no statistically significant difference in the length of hospital stay between the groups. The visual analog score, range of motion, and Knee Society Score were better in the MV group within 1 month (P < .05), but no statistically significant differences were found later. Patellar scores, radiographic patellar tilt, and displacements were similar at all follow-up periods. CONCLUSION: In our study, the MV approach had faster SLR, less LRR, and better pain and function scores in the first few weeks after TKA. However, its effect on different patient outcomes has not been sustained at 1 month and further follow-up points. We recommend that surgeons use the surgical approach with which they are most familiar.

Minimally invasive medial femoral approach to total knee arthroplasty improves short-term outcomes compared to the standard medial parapatellar approach: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study is to conduct a comprehensive evaluation of the effectiveness of the medial parapatellar approach via the vastus medialis obliquus muscle in comparison with the standard medial parapatellar approach for total knee arthroplasty, using a systematic approach. METHODS: A computer search was conducted on PubMed, EMBASE, Medline, Cochrane libraries, and Web of Science databases to comprehensively collect randomized controlled studies on minimally invasive (MMV) approaches for knee arthroplasty, specifically the vastus and medial parapatellar (MP) approaches. Two authors independently screened the literature based on inclusion and exclusion criteria, evaluated the quality of the included studies using the Cochrane systematic review method, and performed a meta-analysis using RevMan 5.3 software. RESULTS: A total of twelve randomized controlled studies were ultimately included, comprising 788 knees. The small incision medial femoral muscle approach (MMV) group consisted of 398 cases, while the traditional parapatellar approach (MP) group consisted of 390 cases. Data analysis showed that in the comparison of KSS, VAS, and ROM score at 3 months after surgery, MMV approach was superior to MP approach [MD = 2.89, 95%CI (0.33, 5.46), P = 0.03], [MD = - 0.22, 95%CI (- 0.36, - 0.09), P = 0.001], and [MD = 1.08, 95%CI (0.04, 2.12), P = 0.04]. However, there was no significant difference in the postoperative KSS, VAS, and ROM score between the MMV and MP approaches at 6 and 12 months after surgery. The operation time of the MMV group was longer than that of the MP group [MD = 8.98, 95%CI (4.64, 13.32), P < 0.0001], and the number of days of straight leg raising after surgery was shorter in the MMV group than in the MP group [MD = - 1.91, 95%CI (- 3.45, - 0.37), P = 0.01], with statistically significant differences. There was no significant difference in the lateral support band release rate [OR = 0.72, 95%CI (0.23, 2.28), P = 0.58], length of hospital stay [MD = 0.07, 95%CI (- 0.18, 0.31), P = 0.58], postoperative complications [MD = 0.62, 95%CI (0.33, 1.18), P = 0.15], and intraoperative blood loss [MD = 70.50, 95%CI (- 57.51, 198.72), P = 0.28]. CONCLUSION: Most of the approaches have similar length of stay and incidence of complications compared to standard approaches. However, the minimally invasive midvastus approach has shown potential to improve short-term outcomes. STUDY REGISTRATION: PROSPERO registration number CRD42023410583.

Mini-midvastus versus medial parapatellar approach in total knee arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score.

BACKGROUND: Low knee awareness after minimally invasive total knee arthroplasty (TKA) has become the ultimate target of a natural-feeling knee that meets patient expectations. The objective of this research was to compare the clinical outcomes of TKA via the mini-midvastus (MMV) approach or the medial parapatellar (MPP) approach, and to evaluate which approach can lead to a better quality of life after surgery. METHODS: From January 2015 to December 2016, a retrospective cohort study was conducted in 330 patients who underwent TKA via a mini-midvastus (MMV) approach. During this period, we also selected 330 patients who underwent TKA via a medial parapatellar (MPP) approach (MPP group) for comparison. Clinical results were assessed with the visual analog scale score for pain, range of motion, and the Knee Society Score. The Forgotten Joint Score was used to analyze the ability to forget the joint. RESULTS: There were significant differences with regard to visual analog scale score, range of motion, and the Knee Society Score until 6 months after surgery between the MMV and MPP groups (p < 0.05), but the differences were not significant at 12 months, 24 months, and 36 months after surgery. However, there were significant differences in the Forgotten Joint Score between the groups during the follow-up period (p < 0.05). CONCLUSION: When forgetting the artificial joint after TKA is the ultimate target, better quality of life can be acquired by performing TKA via the MMV approach. In addition, compared with the MPP approach, the MMV approach can offer less pain and a faster recovery.

Total knee arthroplasty through a midvastus approach reduces postoperative adverse reactions and accelerates functional recovery of the knee / 中国组织工程研究

BACKGROUND: Medial parapatellar approach has become the standard technique for total knee arthroplasty. However, recent studies have reported superior results in functional recovery using midvastus approach. OBJECTIVE: To evaluate the early functional outcomes of medial parapatellar and midvastus approaches. METHODS: This was a prospective, randomized, double-blind, and controlled trial. Fifty patients receiving total knee arthroplasty were randomized into two groups: medial parapatellar approach and midvastus approach. The same type of implants was used in both groups. The Visual Analogue Scale scores were recorded. The range of motion, quadriceps strength and proprioception were assessed at 3 and 6 weeks after surgery. RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores at rest and in active in the midvastus approach group were significantly lower than those in the medial parapatellar approach group. (2) The average quadriceps strength in the midvastus approach group was significantly better than that in the medial parapatellar approach group. (3) The postoperative quadriceps proprioception in the midvastus approach group was better than that in the medial parapatellar approach group. The range of motion was similar in both groups. (4) Therefore, during early rehabilitation, the midvastus approach is superior to the medial parapatellar approach, and no adverse effects associated with this method are observed.

Short Term Result of Minimally Invasive Total Knee Arthroplasty with Mini-Midvastus Approach / 대한정형외과학회잡지

PURPOSE: To investigate the effectiveness of minimally invasive total knee arthroplasty using the mini-midvastus approach through analyzing the short-term clinical outcomes. MATERIALS AND METHODS: Seventy-seven consecutive total knee arthroplasties were performed with the mini-midvastus surgical technique from August 2005 to February 2006 and were followed for more than 1 year after the procedure. All operations were performed with the Nexgen LPS-flex total knee system using a MIS quad-sparing instrument. The evaluation included preoperative and postoperative clinical data, surgical and radiological outcomes. RESULTS: The length of skin incision was average 8.4+/-0.6 cm and the operation time was average 95.5+/-15.7 minutes. The blood loss was average 727.5+/-315.5 cc. The tibial component alignment angles averaged 0.2+/-1.3degrees varus and the tibiofemoral angles averaged 5.8+/-1.8degrees. The mean ROM and the mean HSS score was 117+/-10degrees and 120+/-11degrees, 88.9+/-7.1 and 96.2+/-4.5 at eight weeks and one year after surgery respectively. CONCLUSION: If proper surgical procedures are performed using the appropriate surgical instruments, minimally invasive total knee arthroplasty with the assistance of the mini-midvastus approach, can result in good clinical outcomes and alignment of the implants.

A comparative study about total knee arthroplasty through a mini midvastus approach and traditional medial parapatellar approach / 中国矫形外科杂志

[Objective]To compare clinical results of the mini midvastus approach with the traditional medial parapatellar approach for totall knee arthroplasty and to evaluate their advantages.[Methods]Sixty total knee arthroplasty(56 patients)have been freated during May 2002 to May 2006,28 patients(30 knee) were underwent TKA using either mini midvastus approach or traditional medial parapatellar approach.Two groups were compared according to skin incision length,postoperative pain score,total amount of drains,postoperative amount of decreasing Hb,active straight-leg raise time,postoperative length of stay,radiographic alignment of all the components,postoperative range of motion at 6 weeks and 12 weeks and 1 year,postoperative HSS score at 1 year.[Results]All the patients were followed from 1 to 1.5 year(mean,13.2 months).Position of all the components was normal in all patients except one case with abnormal position of tibial prosthesis in both groups.In the MIS group,the average skin incision length was 11.3 cm,average visual analog pain scale was 2.76 score,while the control group was 20.6 cm and 3.8 score.In the MIS group,the total amount of drains was 96.8 ml,postoperative amount of decreasing Hb was 22.5 g,while the control group was 276.3 ml and 32.5 g.In the MIS group,active straight-leg raise time was 3.8 days,postoperative length of stay was 8.6 days,while the control group was 5.8 days and 12.1 days.In the MIS group,the mean ROM at 6 weeks postoperatively was 107?and 117?at 12 weeks,while the control group was 98?and 108?.The differences between each factor group and operative results were significant(P0.05).[Conclusion]The mini midvastus approach wis associated with a more rapid functional recovery and a more satisfactory short-term result.

Comparison of Midvastus and Medial Parapatellar Approach for Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To compare the results associated with the standard medial parapatellar approach and the midvastus approach in primary total knee arthroplasty. MATERIALS AND METHODS: A total of 70 cases who underwent total knee arthroplasty were evaluated. All patients have varus deformity in standing AP view, but subluxation of the patella on the Merchant view was excluded. Medial parapatellar approach (35 cases) and midvastus approach (35 cases) were used. The operation time, blood loss, incidence of lateral release, time to perform straight leg raising, time to get 90 degrees flexion, range of motion, VAS, Knee Society Knee Scores, tibio-femoral angle and patella tilt were compared. The results were analyzed using the student's t-test. RESULTS: No significant difference was noted between medial parapatellar and midvastus approach regarding to the operation time, blood loss, range of motion, VAS and Knee Society Knee Scores (p>0.05). However, midvastus approach provide two significant advantages of the incidence of lateral release (40% vs 6%) and the time to perform straight leg raising (4.5 days vs 1.9 days) (p<0.05). CONCLUSION: Midvastus approach is an efficacious alternative to the medial parapatellar approach in terms of the excellent exposure and reducing the incidence of lateral retinacular release.

The Comparision of the Midvastus and Paramedian Approaches for Total Knee Arthroplasty

PURPOSE: To present the results of mdivastus and paramedian approach for total knee replacement arthroplasty (TKA). MATERIALS AND METHODS: Thirty two patients having bilateral total knee replacement arthroplasty were randomized prospectively-one knee having a vastus muscle-splitting approach(MVS) and the other knee having a median parapatellar approach(MPP)- to compare the difference in lateral release, operation time, postoperative ROM and drain amount, HSS score, return to SLR and extension lag at 2 weeks in TKA. RESULTS: The MVS approach offered an early advantages compared with MPP approach, especially in terms of lateral release[22(68.7%)on MPP and 5 15.6%) on MVS (p=0.014)], ROM at postoperative 2 week (p=0.043) and early return to SLR (p=0.023). There were no significant differences in operation time, postoperative ROM and drain amount, HSS score and extension lag. CONCLUSION: The MVS approach has the potential to improves the rapid restoration of quadriceps mus-cle control and to lead to reduction in the need for lateral release in TKA.