Comparison of Early Postoperative Rehabilitation Outcome following Total Knee Arthroplasty Using Different Surgical Approaches and Instrumentation Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium. Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique Faster recovery after minimally invasive surgery in total knee arthroplasty Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study Five-year follow-up of minimally invasive computer assisted total knee arthroplasty (MICATKA) versus conventional computer assisted total knee arthroplasty (CATKA) - A population matched study. Comparative study between computer assisted-navigation and conventional technique in minimally invasive surgery total knee arthroplasty, prospective control study. Minimally Invasive Computer-Assisted Total Knee Arthroplasty Compared With Conventional Total Knee Arthroplasty: A Prospective 9-Year Follow-Up. Midvastus approach in total knee arthroplasty: a randomized, double-blinded study on early rehabilitation Minimally invasive total knee arthroplasty: surgical implications for recovery. Clinical outcome using a ligament referencing technique in CAS versus conventional technique Minimal invasive and computer-assisted total knee replacement compared with the minimal invasive technique: a prospective, randomized trial with short-term outcomes Minimally invasive and computer-assisted total knee arthroplasty versus conventional technique: a prospective, randomized study Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study Short-Term Outcome after Computer-Assisted versus Conventional Total Knee Arthroplasty: A Randomised Controlled Trial Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. Conventional versus computer-navigated TKA: a prospective randomized study
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 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 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 Purpose The aim of the study was to identify whether less soft tissue and muscle damage during surgery will allow faster recovery after total knee arthroplasty in comparison with the conventional technique . A limited medial parapatellar approach without tibial medial collateral ligament ( MCL ) desinsertion was compared with the conventional parapatellar approach . Methods Three hundred patients were r and omized either into the minimally invasive group ( MIS group ) or into the conventional group ( CON group ) . The evaluation was based on the Knee Society Score , range of motion , blood loss , period of hospitalization and postoperative hemoglobin level . Results The MIS group showed faster recovery with immediate postoperative full weight-bearing and shorter length of stay ( 5 vs 10 days ) . Comparable Knee Society Scores ( 87.5 vs 88 ) , function scores ( 90 ) and alignment ( 5.5 ° vs 5.2 ° ) between the CON and MIS group were observed at a follow-up of 24 months . No increase in operative times ( 52 vs 51 min tourniquet time ) or no complications were observed . Reduced blood loss was observed in the MIS group ( 590 vs 989 ml ) . Conclusion The MCL sparing limited medial parapatellar approach allows good surgical exposure , easy extension proximally if necessary , contained closure after surgery with less bleeding , faster recovery , full weight-bearing without aid and most importantly no radiological malalignment . Level of evidence Therapeutic study , Level II 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 BACKGROUND Minimally invasive surgery ( MIS ) has perceived advantages in the early post-operative stage such as reduced blood loss , decreased pain , earlier return to function and earlier discharge . The aim of our study was to confirm that longer term clinical outcome of TKA is not compromised when MIS is combined with computer assisted surgery . METHODS Eighty patients matched for age , gender , pre-operative Knee Society Score ( KSS ) and mechanical axis were prospect ively studied . Forty patients underwent minimally invasive computer assisted total knee arthroplasty ( MICATKA ) and 40 patients underwent conventional computer assisted TKA ( CATKA ) .  Functional scores were determined at 6 weeks , 6 , 12 , 18 , and 24 months and 5 years post-surgery . Long-leg alignment views were obtained 3 months post-operatively . RESULTS KSSs in the short term were significantly better in the MICATKA group than in the CATKA group ( p<000.1 ) . Tourniquet-time was 58 min in the MICTKA group and 60 min in the CATKA group ( p=0.3 ) . Straight leg raise was achieved by day one in 93 % of the MICATKA group compared to 30 % of the CATKA group ( p<0.001 ) . Length of stay for the MICATKA group has a mean of 3.25 days and a mean of 6 days for the CATKA group ( p<0.001 ) . KSSs up to 2-years were significantly better in the MICTKA group ( p<0.001 ) . At 5-years there was no significant difference in KSSs ( p=0.46 ) in the MICATKA and CATKA groups . CONCLUSION We confirm that the use of navigation in minimally invasive TKA permits a number of early post-operative advantages and that longer-term functional outcome is not compromised with its usage . LEVEL OF EVIDENCE Level II BACKGROUND Both Minimally Invasive surgery ( MIS ) and Computer-Assisted Surgery ( CAS ) are useful in Total Knee Arthroplasty ( TKA ) . Minimally invasive total knee arthroplasty was associated with decreased blood loss , shorter hospital stays , and increased range of motion .  Computer-assisted surgery in total knee arthroplasty was developed to improve the positioning of implants during surgery . OBJECTIVE To evaluate radiographic results relative to component position and limb alignment when using a navigation system compared with conventional technique in MIS-TKA . MATERIAL AND METHOD A prospect i ve control study was performed in 180 patients who underwent total knee arthroplasty by one surgeon . All patients were r and omly divided into two groups , Conventional and Navigation TKA .  Intra- , post-operative data , and postoperative limb alignment were recorded for comparison in both groups . RESULTS The postoperative mechanical axis was within 3 degrees of neutral mechanical alignment in 94 % of the navigation group and 87 % in conventional group ( p = 0.13 ) . Registration time of navigation group is 13.58 minutes . No statistical significant difference was found in tourniquet time and postoperative blood loss in both groups . CONCLUSION The use of navigation in total knee arthroplasty increases accuracy in limb and implants alignment , and does not increase complications and surgical times BACKGROUND Studies on minimally invasive computer-assisted total knee arthroplasty ( MICA-TKA ) have shown promising results , but are limited by short follow-up . The purpose of this study was to compare the midterm radiographic features and functional outcomes between patients who underwent MICA-TKA and conventional TKA .  METHODS A total of 108 patients who were r and omized to undergo MICA-TKA or conventional TKA during 2004 and 2005 were contacted for a prospect i ve follow-up review . Patients who were lost to contact , have passed away , or declined to participate in the study were excluded . Objective functional measurements and radiographs were obtained for assessment . RESULTS By the time of this study , 2 patients from the conventional group had undergone revision TKA , one due to infection and one due to aseptic loosening . A total of 67 patients ( 62.04 % ) were followed up for an average period of 9.07 years ( 8.51 - 9.61 years ) . At follow-up , functional scores were comparable between the 2 groups . No significant intergroup differences were found in mechanical knee alignment and component placement angle in the coronal views . No statistical or clinical significance were noticed in radiographic signs of component loosening . CONCLUSIONS MICA-TKA provided similar clinical , functional , and radiographic outcomes compared with conventional TKA after an average of 9-year follow-up . This technique can be used to exploit its short-term advantages without compromising midterm outcomes 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 BACKGROUND Despite growing interest in minimally invasive surgery ( MIS ) techniques for total knee arthroplasty ( TKA ) , few r and omized controlled trials have compared MIS and conventional TKA using a combination of functional performance , knee pain , knee range of motion ( ROM ) , and surgical and radiographic outcomes . METHODS A prospect i ve , r and omized investigation comparing early outcomes of TKA using conventional or MIS approaches  ( n = 44 ) . Patients were assessed preoperatively , 48 hours , 4 and 12 weeks postoperatively by blinded evaluators . Outcome measures included timed-up- and -go , 100-ft walk , knee pain , passive knee ROM , Knee Society Score , blood loss , tourniquet time , hospital length of stay , surgical complications , and radiographic outcomes . RESULTS No significant differences in functional performance , knee pain , knee ROM , surgical , or radiographic outcomes were observed between groups at 48 hours , 4 or 12 weeks postoperatively . CONCLUSION While surgical and radiographic outcomes were not compromised with MIS surgery , there were also no improvements in pain , ROM , or functional performance with MIS TKA Purpose Computer-assisted surgery ( CAS ) for total knee arthroplasty ( TKA ) has become increasingly common over the last decade . There are several reports including meta-analyses that show improved alignment , but the clinical results do not differ . Most of these studies have used a bone referencing technique to size and position the prosthesis . The question arises whether CAS has a more pronounced effect on strict ligamentous referencing TKAs . Methods We performed a prospect i ve cohort study comparing clinical outcome of navigated TKA ( 43 patients ) with that of conventional TKA ( 122 patients ) . Patients were assessed preoperatively , and 2 and 12 months postoperatively by an independent study nurse using vali date d patient-reported outcome tools as well as clinical examination . Results At 2 months , there was no difference between the two groups . However , after 12 months , CAS was associated with significantly less pain and stiffness , both at rest and during activities of daily living , as well as greater overall patient satisfaction . Conclusion The present study demonstrated that computer-navigated TKA significantly improves patient outcome scores such as WOMAC score ( P = 0.002 ) and Knee Society score ( P = 0.040 ) 1 year after surgery in using a ligament referencing technique . Furthermore , 91 % were extremely or very satisfied in the CAS TKA group versus 70 % after conventional TKA ( P = 0.007 ) Abstract Introduction Up to now , no prospect i ve , r and omized comparisons between minimal invasive and computer-assisted total knee arthroplasty ( MICA-TKA ) , and minimal invasive technique ( MI-TKA ) has been documented to evaluate not only clinical , but also radiologic results of the MICA-TKA . This prospect i ve , r and omized study was performed to compare the short-term results of MICA-TKA with minimal invasive technique MI-TKA for 6-month follow-up . Patients and methods We reported the clinical and radiological results of 80 subjects who had cruciate-substituting , TKA-implanted primary total knee arthroplasties using either minimal invasive and computer-assisted technique ( 40 patients Group I ) or minimal invasive technique ( 40 patients , Group II ) .  Tourniquet time , length of skin incision , and total blood loss were compared . Knee society scores ( KSSs ) , knee society functional scores ( KSFSs ) , range of motion ( ROM ) , and radiographic results were assessed and reported preoperatively and at 6-month follow-up . Results The accuracy of the implantations in relation to the coronal mechanical axis in Group I was superior to that of Group II ( P < 0.05 ) . The femoral rotational profile revealed the prosthesis in Group I that was implanted with significantly less internal rotation than in Group II . The average blood loss in patients of Group I was significantly reduced as compared to patients of Group II . No significant difference was detected in terms of tourniquet time or length of skin incision . Clinical results , with regard to ROMs and KSSs , as well as KSFSs were equally good in both the groups . Conclusions Better alignment and similarity of good clinical results at short-term follow-up may provide subjects who receive MICA-TKA with long-term endurance of their implants . Further studies on longer-term outcomes and functional improvements are required to vali date these possibilities We conducted a prospect i ve , r and omized study to compare the short-term results of minimally invasive and computer-assisted total knee arthroplasty ( MICA-TKA ) with those of conventional total knee arthroplasty ( C-TKA ) for 12-month follow-up . A total of 87 subjects who met the inclusion and exclusion criteria of the study were prospect ively r and omized consecutively into two groups : the C-TKA group ( Group A , n = 44 ) and the MICA-TKA technique ( Group B , n = 43 ) . All the operations were performed by the same senior surgeon . Before surgery and at follow-up , patients were evaluated by the same observer . Tourniquet time as well as total blood loss was compared . Knee Society scores ( KSSs ) , Knee Society functional scores ( KSFSs ) , range of motion ( ROM ) , and radiographic results were assessed and reported preoperatively and at 12-month follow-up . Of these patients , 82 ( Group A 42 ; Group B 40 ) were available for 12-month evaluation . The two groups were found to be similar in terms of coronal mechanical axis . Similarly , the femoral rotational profile revealed that the prosthesis in Group A was implanted with similar internal rotation to Group B. The average blood loss in patients of Group B was significantly reduced as compared to patients of Group A. No significant difference was detected in terms of tourniquet time . Clinical results in Group B , with regard to ROMs and KSSs , as well as KSFSs were significantly superior to that in Group A. Based on the results obtained from this study , it is demonstrated that MICA-TKA leads to a similarly accurate restoration of leg alignment and component orientation compared to the C-TKA . Moreover , MICA-TKA produces superior clinical results to that of C-TKA . However , there is clearly a need for additional high- quality clinical trials with long-term follow-up to confirm the clinical benefits of MICA-TKA Purpose The aim of this study was to compare radiological results of total knee arthroplasties ( TKAs ) performed with patient-specific computed tomography (CT)-based instrumentation and conventional technique . The main study hypothesis was that CT-based patient-specific instrumentation ( PSI ) increases the accuracy of TKA . Methods A prospect i ve , r and omized controlled trial was carried out between January and December 2011 . A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and r and omly assigned to an experimental or control group . The experimental group comprised 52 patients operated on with the aid of the Signature ™ CT-based implant positioning system .  The control group consisted of 60 patients operated on using conventional instrumentation .  The radiographic evaluation of implant positioning and overall coronal alignment was performed 12 months after the surgery by using st and ing anteroposterior radiographs of the entire lower limb and st and ard lateral radiographs . Results Of the 112 patients initially enrolled for the study , 95 were included in the subsequent analyses . There were no statistically significant differences between groups in respect to coronal and sagittal component positioning and overall coronal alignment , except for frontal tibial component positioning . For this parameter , better results were obtained in the control group , with borderline statistical significance . Conclusions Our study did not reveal superiority of the CT-based PSI system over conventional instrumentation . Further high- quality investigations of patient-specific systems are absolutely indispensable to assess their utility for TKA . In our opinion , the surgeon applying PSI technology is required to have advanced knowledge and considerable experience with the conventional method Purpose . To compare the short-term functional outcome after computer-assisted total knee arthroplasty ( TKA )  versus conventional TKA . Methods . 23 men and 67 women aged 48 to 80 years were r and omised to undergo ( 1 ) conventional TKA using an intramedullary guide , ( 2 ) conventional TKA using an extramedullary guide , or ( 3 ) computer-assisted TKA . Two senior surgeons performed all the TKAs using the same TKA system and the st and ard anteromedial arthrotomy with eversion of the patella . Patients were assessed by physiotherapists before and 6 months and 2 years after TKA using the Short Form-36 Health Survey , Oxford Knee Score , and Knee Society Score . Results . Of the 90 patients , 67 and 70 were assessed at 6 months and 2 years after TKA , respectively . No patient developed deep infection or required revision surgery . Functional outcomes of the 3 groups did not differ significantly at the corresponding follow-ups . Conclusion . Significant improvement in the functional outcome was not shown in patients treated with  computer-assisted TKA  , compared with conventional TKA . Thus , computer-assisted TKA has limited additional short-term benefits . Further studies with longer follow-up are required to examine the benefits of computer-assisted TKA Robot-assisted Total Knee Arthroplasty ( TKA ) improves the accuracy and precision of component implantation and mechanical axis ( MA ) alignment . Joint-line restoration in robot-assisted TKA is not widely described and joint-line deviation of>5 mm results in mid-flexion instability and poor outcomes . We prospect ively r and omised 60 patients into two groups : 31 patients ( robot-assisted ) , 29 patients ( conventional ) .  No MA outliers ( > ±3 ° from neutral ) or notching was noted in the robot-assisted group as compared with 19.4 % ( P=0.049 ) and 10.3 % ( P=0.238 ) respectively in the conventional group . The robot-assisted group had 3.23 % joint-line outliers ( > 5 mm ) as compared to 20.6 % in the conventional group ( P=0.049 ) . Robot-assisted TKA produces similar short-term clinical outcomes when compared to conventional methods with reduction of MA alignment and joint-line deviation outliers Purpose The purpose of this study was to assess the midterm results of total knee arthroplasty ( TKA ) implanted with  a specific computer navigation system in a group of patients ( NAV ) and to assess the same prosthesis implanted with the conventional technique in another group ( CON ) ; we hypothesized that computer navigation surgery would improve implant alignment , functional scores and survival of the implant compared to the conventional technique . Methods From 2008 to 2009 , 225 patients were enrolled in the study and r and omly assigned in CON and NAV groups ; 240 consecutive mobile-bearing ultra-congruent score ( Amplitude , Valence , France ) TKAs were performed by a single surgeon , 117 using the conventional method and 123 using the computer-navigated approach .  Clinical outcome assessment was based on the Knee Society Score ( KSS ) , the Hospital for Special Surgery Knee Score and the Western Ontario Mac Master University Index score . Component survival was calculated by Kaplan – Meier analysis . Results Median follow-up was 6.4 years ( range 6–7 years ) . Two patients were lost to follow-up . No differences were seen between the two groups in age , sex , BMI and side of implantation . Three patients of CON group referred feelings of instability during walking , but clinical tests were all negative . NAV group showed statistical significant better KSS Score and wider ROM and fewer outliers from neutral mechanical axis , lateral distal femoral angle , medial proximal tibial angle and tibial slope in post-operative radiographic assessment . There was one case of early post-operative superficial infection ( caused by Staph . Aureus ) successfully treated with antibiotics . No mechanical loosening , mobile-bearing dislocation or patellofemoral complication was seen . At 7 years of follow-up , component survival in relation to the risk of aseptic loosening or other complications was 100 % . There were no implant revisions . Conclusion This study demonstrates superior accuracy in implant positioning and statistical significant better functional outcomes of computer-navigated TKA . Computer navigation for TKAs should be used routinely in primary implants . Level of evidence II
There was no significant difference in the outliers on complications , knee flexion , and postoperative functional scores .
Coronal plane tibial component showed statistically significant number of outliers in the MIS group demonstrating superior component positioning in the MIS CA group .
Computer-assisted minimally invasive TKA is superior than the st and ard MIS TKA in terms of component positioning ; however , it is unclear if this will have any long-term clinical implication s. The increased operative time , although clinical ly relevant , does not appear to be associated with an increase in complications
BACKGROUND Median parapatellar approach is the most used for total knee arthroplasty ( TKA ) .
With the advent of enhanced recovery and shorter length of hospital stay , there is an increasing pressure on surgeons to perform surgery through smaller incisions .
Minimally invasive ( MIS ) TKA allows earlier functional recovery ; it is not clear if this is associated with more complications .
It is also unclear if computer-assisted minimally invasive ( MIS CA ) TKA has any affect on improving patient outcomes .
We performed a systematic review and meta- analysis comparing MIS CA vs MIS TKA .