Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium. Comparison of the mini-midvastus with the mini-medial parapatellar approach in primary TKA. Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation Mini-midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty. Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study [Functional Comparison of the Outcome after Midvastus and Medial Parapatellar Surgical Approach in Total Knee Arthroplasty]. Mini-midvastus versus medial parapatellar approach in TKA: muscle damage and inflammation markers. Comparison of Early Postoperative Rehabilitation Outcome following Total Knee Arthroplasty Using Different Surgical Approaches and Instrumentation Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique A midvastus muscle-splitting approach for total knee arthroplasty. Quadriceps-sparing, minimal-incision total knee arthroplasty: a comparative study. Approach to Total Knee Replacement: A Randomized Double Blind Study between Medial Parapatellar and Midvastus Approach in the Early Postoperative Period in Asian Population Subvastus versus medial parapatellar approach in total knee arthroplasty Early results of subvastus versus medial parapatellar approach in primary total knee arthroplasty A comparison of subvastus and midvastus approaches in minimally invasive total knee arthroplasty. Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA
Comparisons between mini-midvastus ( mMV ) and mini-medial parapatellar approach ( mMPP ) for total knee arthroplasty ( TKA ) have reported variable results . We compared two approaches with minimum two year follow up . Forty consecutive patients who underwent staged bilateral TKA were prospect ively r and omized for mMPP approach in one knee and mMV approach in the other . Clinical parameters ( muscle strength , pain , ROM , Knee Society Score ) and surgic.l parameters ( duration of surgery , blood loss , lateral releases ) were assessed at 2 , 6 , 12 weeks and 6 , 12 , 24 months postoperatively . Clinical outcomes revealed inconsistent pattern of differences at various intervals . Surgical outcomes were not different . There were no major differences in outcomes between the two approaches . We recommend someone use surgical approach with which they are most familiar A prospect i ve r and omized study was performed to compare the clinical and radiological results of primary total knee arthroplasties ( TKAs ) using a mini-midvastus approach or a mini-medial parapatellar approach in 134 patients . The mini-midvastus approach was used on 68 patients ( group A ) and the mini-medial parapatellar approach on 66 patients ( group B ) . All knees were implanted with the same posterior-stabilized prosthesis by the same surgeon ( T.-S.T. ) with the same set of downsized instruments . Mean follow-up in both groups was 30.5 months ( range , 24 - 48 months ) . Patients in group A achieved an active straight-leg raise and 90 ° of flexion significantly earlier ( P=.017 and P=.025 , respectively ) . However , no significant difference was detected between the groups with respect to range of movement and Knee Society scores at all the postoperative visits and at final follow-up ( all , P>.05 ) . In contrast , the tourniquet time was significantly longer in group A ( P=.015 ) , with a higher incidence of medialized tibial component ( P=.031 ) . We believe that the early clinical results are similar between the mini-midvastus and mini-medial parapatellar approach . The mini-medial parapatellar approach is easier to initially apply and provides better visualization for TKA The medial parapatellar approach has become the st and ard technique in total knee arthroplasty ( TKA ) . However , recent studies have reported superior results regarding functional recovery when using the midvastus approach . It was the aim of this study to evaluate the early functional outcome of both surgical techniques . In a prospect i ve , double-blinded , r and omized study , 50 patients for TKA were consecutively operated on either by the medial parapatellar or the midvastus approach . Exclusion criteria were defined as previous open knee surgery and leg deformity of more than 10 ° varus or valgus . TKA was performed in all patients by one surgeon using the same type of implants in both groups . Pain scores ( VAS ) were documented and follow-up data including quadriceps strength and proprioception were obtained 3 weeks and 6 weeks postoperatively . Both groups were comparable in preoperative demographic data . Postoperatively , patients in the midvastus group demonstrated significantly lower pain in rest ( VAS : mean 2.25 vs. 3.03 ) and under movement ( VAS : mean 2.92 vs. 3.13 ) . Further , they showed superior isometric quadriceps strength at 3 weeks ( 41.4 vs. 27.6 Nm ) and 6 weeks ( 47.6 vs. 35.5 Nm ) . Moreover , this group showed a superior postoperative proprioception , while the range of motion was similar in both groups . The midvastus approach offers advantages over the st and ard parapatellar arthrotomy , in the early rehabilitation period . No adverse effects were observed associated with this approach . Therefore , the midvastus approach should be considered as a valuable alternative in TKA The purpose of this study was to determine whether the mini-midvastus approach to total knee arthroplasty ( TKA ) results in differences in quadriceps muscle strength as well as previously cited advantages in a double blind prospect i ve r and omized trial . Twenty-seven patients ( 54 TKAs ) scheduled for bilateral TKA were r and omized to undergo mini-midvastus approach on one knee and st and ard approach on the other . Incision lengths were the same . Postoperative strength was determined by isokinetic and isometric peak torque testing . Range of motion , pain Visual analog scale , side-preference , and gait analysis were assessed preoperatively and postoperatively . The only significant difference in strength testing was increased isokinetic and isometric extension torque at 3 weeks postoperatively for the mini-midvastus approach . No differences between the mini-midvastus and st and ard approach were observed for stride length , stance time , pain Visual analog scale , or knee range of motion . The mini-midvastus approach has limited benefit compared to the st and ard approach for TKA Purpose Whether minimally invasive total knee arthroplasty ( MIS-TKA ) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial . This prospect i ve and r and omized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA .  Methods Fifty patients , including 50 knees , who required TKA due to osteoarthritis were r and omized to the mini-subvastus group ( group I ) or the medial parapatellar group ( group II ) . All patients accepted the same method of anaesthesia , equal support therapy and identical rehabilitation exercise after surgery . The evaluation system included operation time , tourniquet time , blood loss , skin incision length in flexion , straight leg raising time , the time of lower limb muscle strength up to grade 4 , the time of walking with aid or without aid , the time of walking up and down the stairs , the active flexion angle , range of movement ( ROM ) , the Knee Society Scores ( KSS ) , visual analogue score for pain ( VAS ) , hospital stays and radiographic outcomes . Results The mini-subvastus approach offered smaller skin incision length in flexion , but at the cost of operation time ( P < 0.001 ) . No significant difference was found in tourniquet time and blood loss . The patients in group I could achieve straight leg raising , the lower limb muscle strength up to grade 4 , walking with or without aid , and walking up and down the stairs earlier ( P < 0.001 ) . The active flexion angle , ROM , VAS and KSS in group I were superior to those in group II until six months post-operatively ( P < 0.001 ) , but the differences was not apparent at 12 months post-operatively . More importantly , there was no significant difference between the two groups on radiological outcomes ( P > 0.05 ) . Conclusions The mini-subvastus approach could offer faster recovery , less pain and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the medial parapatellar approach There are various approaches for total knee arthroplasty ( TKA ) . On the basis of an analysis of the clinical results , it has been demonstrated that the midvastus approach ( MV ) is advantageous in the early postoperative period compared to the medial parapatellar surgical approach ( MPP ) . The aim of this investigation was therefore to investigate whether the clinical advantage of MV is reflected in the functional outcome . This single blinded , prospect i ve , r and omised study was based on a power analysis . Selected r and omised patients ( MPP = 10 , MV = 11 ) were examined using an instrumental gait analysis system ( VICON ) preoperatively , and 5 weeks ( 5 W ) and 6 months ( 6 M ) after implantation . The results were compared to a healthy control group ( CG = 53 ) . Besides clinical parameters , the primary objective of this study was to measure objective gait parameters ; the secondary objective was to record self- assessment ( Knee Society score , WOMAC ) . In both treatment groups , the measurements improved during the investigation period , although most parameters did not reach the CG levels . MV gave better values for the kinetic parameters sagittal knee moment ( 5 W ) and knee power ( 5 W , 6 M ) , as well as self- assessment ( WOMAC , 6 M ) . Other clinical parameters were similar in the two groups . In summary , in the early postoperative period , MV led to advantages in function and in subjective behaviour in daily life . From the biomechanical point of view , the MV approach is preferable The purpose of this prospect i ve study was to analyze the biochemical markers of muscle damage and inflammation in patients treated with the mini-midvastus approach or the medial parapatellar approach for total knee arthroplasty . Of 60 patients who underwent unilateral total knee arthroplasty , 30 were treated with the mini-midvastus approach ( MMV group ) and 30 were treated with the  medial parapatellar approach ( MPP group ) . Serum creatine kinase , myoglobin , lactate dehydrogenase , glutamic oxaloacetic transaminase , C-reactive protein , interleukin-6 , and interleukin-1β levels were measured preoperatively , immediately postoperatively ( except for C-reactive protein level ) , and on postoperative days 1 , 2 , and 3 . Student 's t test , Pearson 's chi-square test , and Fisher 's exact test were used to compare the outcomes between the 2 groups . Compared with the MPP group , a significant increase in serum creatine kinase level existed in the MMV group on postoperative days 2 ( P=.08 ) and 3 ( P=.09 ) and cumulatively ( P=.02 ) . However , significantly elevated C-reactive protein and interleukin-6 levels existed in the MPP group . According to the serum creatine kinase levels , the mini-midvastus approach has no superiority over the medial parapatellar approach in terms of sparing muscle and may cause more muscle damage . Further study is warranted to determine the correlation between biochemical markers and functional deficits Purpose . To assess early postoperative rehabilitation outcome following  computer-assisted total knee arthroplasty ( TKA )  or st and ard instrumentation TKA using a medial parapatellar or subvastus approach . Methods . A prospect i ve controlled trial of 70 consecutive patients undergoing TKA with a low contact stress rotating platform prosthesis was conducted . Patients were r and omised to receive surgery with either computer navigation or st and ard instrumentation .  A medial parapatellar or subvastus approach was used according to the surgeons ' preference . Outcome measures included preoperative knee function , intra-operative factors , and postoperative rehabilitation . Results . Duration of surgery was significantly longer when using computer navigation ; however , operating time decreased with greater experience . A higher incidence and duration of early postoperative quadriceps dysfunction was associated with computer-assisted TKA through the medial parapatellar approach than through the subvastus approach or TKA performed with st and ard instrumentation . No patient who received surgery through the subvastus approach had a lag of more than 20 degrees , at 48 hours postoperatively , regardless of the instrumentation used . Conclusion . Computer-assisted TKA through a medial parapatellar approach was associated with delayed recovery of the quadriceps during early postoperative rehabilitation . This was due to the additional quadriceps dissection required to place the femoral tracking array . The subvastus approach is therefore recommended for computer-assisted TKA Background Despite the growing evidence in the literature there is still a lack of consensus regarding the use of minimally invasive surgical technique ( MIS ) in total knee arthroplasty ( TKA ) . Methods A prospect i ve , r and omized , international multicentre trial including 69 patients was performed to compare computer-assisted TKA ( CAS-TKA ) using either mini-midvastus ( MIS group ) or st and ard medial parapatellar approach ( conventional group ) .  Patients from 3 centers ( Maastricht , Zwickau , Adelaide ) with end-stage osteoarthritis of the knee were r and omized to either an MIS group with dedicated instrumentation or a conventional group to receive cruciate retaining CAS-TKA without patella resurfacing .  The primary outcome was to compare post operative pain and range of motion ( ROM ) . The secondary outcome was to measure the duration of surgery , blood loss , chair rise test , quadriceps strength , anterior knee pain , Knee Society Score (KSS),WOMAC scores , mechanical leg axis and component alignment . Results Patients in the MIS group ( 3.97 ± 2.16 ) had significant more pain at 2 weeks than patients in the conventional group ( 2.77 ± 1.43 ) p = 0.003 . There was no significant difference in any of the other primary outcome parameters . Surgery time was significantly longer ( p < 0.001 ) and there were significantly higher blood loss ( p = 0.002 ) in the MIS group as compared to the conventional group . The difference of the mean mechanical leg alignment between the groups was not statistically significant ( –0.43 ° ( 95 % CI –1.50 – 0.64 ) ; p = 0.43).There was no significant difference of component alignment between the two surgical groups with respect to flexion/extension ( p = 0.269 ) , varus/valgus ( p = 0.653 ) or rotational alignment ( p = 0.485 ) of the femur component and varus valgus alignment ( p = 0.778 ) or posterior slope ( p = 0.164 ) of the tibial component . Conclusion There was no advantage of the MIS approach compared to a conventional approach CAS-TKA in any of the primary outcome measurements assessed , however the MIS approach was associated with longer surgical time and greater blood loss . MIS-TKA in combination with computer navigation is safe in terms of implant positioning . Trial registration number Clinical Trials.gov NCT02625311 8 December This study presents a modification of the medial parapatellar surgical approach for total knee arthroplasty . This approach separates the vastus medialis muscle in the direction of its fibers beginning at the superior pole of the patella . One hundred eighteen consecutive total knee arthroplasty cases , performed by a single surgeon , were r and omized prospect ively to receive a medial parapatellar or midvastus muscle-splitting surgical approach . The frequency of lateral retinacular releases was recorded , patellar tilt and translation were measured , and quadriceps strength was tested . The midvastus muscle-splitting approach provided excellent exposure to all knees . Patellar stability and quadriceps strength were equivalent for the two approaches . It is concluded that the midvastus muscle-splitting approach is an efficacious alternative to the medial parapatellar approach for primary total knee arthroplasties Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty ( TKA ) : the minimal-incision medial parapatellar ( MP ) approach and the quadriceps-sparing ( QS ) approach with side-cutting instruments . Sixty patients ( 80 knees ) with primary osteoarthritis were r and omly assigned to receive MP or QS TKA .  Postoperative alignment of the femoral component was significantly less valgus , and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach . One tibial outlier and 3 femoral outliers were observed with QS TKA . The overall postoperative hip-knee-ankle axis was more varus , and surgical time was longer with QS TKA .  Short-term isokinetic peak muscle torque , postoperative pain , and functional outcomes did not differ between the approaches & NA ; The purpose of this r and omized study was to compare clinical and surgical outcomes of total knee replacements ( TKRs ) in the early postoperative period using midvastus approach versus medial parapatellar approach in Asian population in a double blind manner . Forty‐two knees each were operated using midvastus approach and the medial parapatellar approach .  Clinical parameters that were evaluated included Knee Society score ( KSS ) ; knee pain using visual analogue scale ( VAS ) on day 1 , 1 week , and 1 month ; time required to straight leg raise ( SLR ) ; patellar tracking ; mean extensor lag at 1 week and 1 month ; and time of discharge from the hospital . Surgical parameters that were evaluated included tourniquet time , incidence of lateral retinacular release , estimated blood loss , and any complications during the surgery . KSS at 1 week and 1 month postoperatively were significantly higher in the midvastus group as compared with medial parapatellar group ; though similar at 3 months , 6 months , and 1 year . The patients in midvastus group required fewer number of lateral retinacular releases ; achieved SLR earlier ; had less mean extensor lag at 1 week ; had less mean VAS score at day 1 , 1 week , and 1 month ; and had shorter hospital stay . There was no significant difference in the mean tourniquet time and estimated blood loss . One patient had patellar maltracking in the medial parapatellar group as compared with none in midvastus group . Midvastus approach to TKR results in quicker functional recovery with early discharge and rehabilitation in the Asian population as compared with medial parapatellar approach Abstract . The subvastus approach for total knee replacement was compared with the st and ard medial parapatellar approach in terms of postoperative knee scores and quadriceps strength . Two groups of patients with similar characteristics were formed : the first group consisted of 12 knees of 9 patients who were implanted via the medial parapatellar approach , and for the second group the subvastus approach was used in 10 knees of 10 patients . The groups ' knee scores and quadriceps strength were compared preoperatively and postoperatively at week 6 , months 3 and 6 . The knee scores improved similarly in both groups , but the change was more pronounced in the subvastus group . Quadriceps strength was greater in the subvastus group at postoperative week 6 , but there was no significant difference between the groups in months 3 and 6 . It was concluded that although the subvastus approach offers greater quadriceps strength in the early postoperative period , it has no significant advantage in this aspect over the medial parapatellar approach Introduction To evaluate the clinical and radiographic results immediately after total knee arthroplasty , we compared the parapatellar and subvastus approach . Material s and methods Fifty-two patients with osteoarthritis were r and omly assigned to two groups . The measurement was based on clinical and radiographic features . Results There was a significant difference in passive range of motion . Patients in the subvastus approach group revealed a full knee extension and flexion of 90 ° significantly earlier than those in the parapatellar group . However , on the day of discharge , both groups were comparable . Radiological assessment revealed analogous results in both groups . Correction of varus or valgus deformity was required in 48 patients . Conclusion Regardless of the surgical approach , the anteroposterior tibial femoral angle improved significantly in both groups . Concerning pain , operation time , blood loss , blood substitution and complications , no major differences could be seen BACKGROUND The mini-subvastus and the mini-midvastus approaches are among the most common alternatives to the medial parapatellar approach for total knee arthroplasty . The purpose of this study was to compare the early clinical outcomes of these two approaches . METHODS In this prospect i ve , r and omized study of fifty-one patients who underwent bilateral total knee arthroplasty , the mini-subvastus approach was used in one knee and the mini-midvastus approach , in the contralateral knee . There were forty-two women and nine men who had a mean age of seventy years at the time of the index arthroplasties , and they were followed for two years postoperatively . Clinical outcome was assessed and compared with use of the Knee Society pain and function scores , the straight-leg-raising test , range of motion , and isokinetic strength testing . Operating time and blood loss for each approach were also compared . In addition , patients were surveyed concerning which knee they preferred . RESULTS Comparisons of postoperative Knee Society scores between both approaches at the time of the two-year follow-up did not yield a significant difference in outcome . Isokinetic strength testing at twelve weeks postoperatively revealed no significant differences in muscle strength , with a mean extensor peak torque-to-body weight ratio of 0.14 Nm/kg for both groups . No significant difference was found with respect to total blood loss , straight-leg-raising test , range of motion , or patient preference . There was no clinical ly relevant difference in operative times between the two approaches . CONCLUSIONS The minimally invasive subvastus and midvastus approaches for total knee arthroplasty were both associated with excellent short-term clinical results . Some surgeons believe that the subvastus approach completely avoids damage to the quadriceps mechanism and therefore would be associated with improved muscle function . This prospect i ve series did not identify a substantive difference between the two approaches . We believe that the decision between these surgical approaches should be based on surgeon preference and experience This pilot double blind r and omised controlled study aim ed to investigate whether the midvastus ( MV ) approach without patellar eversion in total knee arthroplasty ( TKA ) result ed in improved recovery of function compared to the medial parapatellar ( MP ) approach . Patients were r and omly allocated to either the MV approach or the MP approach . Achievements of inpatient mobility milestones were recorded . Knee kinematics , muscle strength , Timed Up and Go , WOMAC , and daily step count were assessed before and up to six months after surgery . Cohen 's effect size d was calculated to inform the sample size in future trials . Twenty-eight participants ( 16 males , 12 females ) participated .  Patient mobility milestones such as straight leg raise were achieved on average 1.3 days ( 95 % CI −3.4 to 0.7 , d = 0.63 ) earlier in the MV group . Knee extensor strength at 6 weeks after surgery was higher ( 95 % CI −0.38 to 0.61 , d = 0.73 ) in the MV group . No trends for differences between the groups were observed in knee kinematics , TUG , WOMAC , or step count . Our results suggest a short term advantage in the first 6 weeks after surgery of the MV approach over the MP approach , but a larger study is required to confirm these findings . This trial is registered with NCT056445 Background Since the medial parapatellar ( MPP ) approach in conventional TKA can cause patellar maltracking and anterior knee pain , some orthopaedic surgeons use the midvastus ( MV ) approach instead of the MPP approach to reduce patellar maltracking . Minimally invasive surgical ( MIS ) TKA has been developed to limit the damage to the surrounding muscle and reduce the necessity of patellar eversion during surgery . Thus , MIS TKA might be associated with proper patellar tracking and a low incidence of anterior knee pain . However , this presumption has not been confirmed . Questions / purpose sWe asked whether the incidence of patellar maltracking and anterior knee pain differed with the MV and MPP in association with MIS TKA . Methods We prospect ively followed 59 patients ( 60 knees ) treated with 60 primary cemented MIS TKAs from August 2009 to September 2010 . We r and omized the patients into two groups : 30 who had a limited MPP approach and 30 who had a mini-MV approach . We recorded the occurrence of anterior knee pain , patellar tilting , and subluxation . The minimum followup was 12 months ( mean , 18.03 months ; range , 12.00–25.08 months ) . Results We found no differences in anterior knee pain ( two of 30 , 7 % versus two of 30 , 7 % ) , mean patellar tilt ( 3.4º ± 2.9º versus 3.0 ± 2.3º ) , and mean patellar subluxation ( 1.5 ± 1.1 mm versus 1.1 ± 0.7 mm ) between the limited MPP and mini-MV groups , respectively . Conclusions MIS TKA using either the MPP or MV approach has a low incidence of patellar maltracking and anterior knee pain . Level of Evidence Level I , therapeutic study . See the Guidelines for Authors for a complete description of the levels of evidence
The MSV approach ranked better concerning clinical scores ( the lowest visual analogic scale , the higher KSS and KSFS ) and functional outcomes ( the shortest straight leg raise , the greatest degree of flexion and range of motion ) .
Concerning perioperative data , the MSV evidence d the shortest hospital stay , while the MPP the shortest surgical duration and lowest estimated blood loss .
According to the main findings of the present study , the mini-subvastus approach for total knee arthroplasty demonstrated superior overall compared to the other approaches .
Alternatives to the classical medial parapatellar ( MPP ) approach for total knee arthroplasty ( TKA ) include the mini-medial parapatellar ( MMPP ) , mini-subvastus ( MSV ) , mini-midvastus ( MMV ) and quadriceps-sparing ( QS ) approaches .
The best approach has been not fully clarified .
The purpose of the present study was to conduct a Bayesian network meta- analysis comparing these approaches .