Hongming LIU, Xiaoliang MEI, Zhenxiang ZHANG, Junying SUN

Mini-midvastus versus mini-medial parapatellar approach in simultaneous bilateral total knee arthroplasty with 24-month follow-up

Objective: Comparisons of mini-midvastus (mMV) with mini-medial parapatellar (mMPP) approach in total knee arthroplasty (TKA) have been performed in the past but were often compromised by variables such as disease, pain tolerance, bone quality, and surgeon. The aim of this study was to minimize the influence of these factors in order to more accurately evaluate these 2 approaches.Methods: Forty-five patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion (ROM) on both sides agreed to have 1 knee replaced via mMV approach (Group I) and the other via mMPP approach (Group II) were evaluated. Postoperative clinical outcomes, postoperative complications, perioperative parameters, and knee component positioning were analyzed.Results: No significant differences were found between the mMV and mMPP groups with regards to functional assessment, patient satisfaction, postoperative complication, quadricep strength, pain at the point of incision, degree of soft tissue release, as well as ROM. Nor were significant differences found between the 2 groups in terms of perioperative parameters and radiographic component positioning.Conclusion: The present study did not detect any substantive difference between the mMV and mMPP approaches for TKA. The decision between the 2 surgical approaches should be based on surgeon experience and preference.

___

Zhang Z, Zhu W, Zhu L, Du Y. Superior alignment but no difference in clinical outcome after minimally invasive computer-assisted unicompartmental knee arthroplasty (MICA-UKA). Knee Surg Sports Traumatol Arthrosc 2014. [Epub ahead of print]

Yoo JH, Park BK, Han CD, Oh HC, Park SH. Minimum 5-year Follow-up Results of Minimally Invasive Total Knee Arthroplasty Using Mini-Keel Modular Tibial Im- plant. Knee Surg Relat Res 2014;26:149-54.

Khakha RS, Chowdhry M, Norris M, Kheiran A, Patel N, Chauhan SK. Five-year follow-up of minimally invasive computer assisted total knee arthroplasty (MICATKA) versus conventional computer assisted total knee arthro- plasty (CATKA) - A population matched study. Knee 2014;21:944-8.

Tenholder M, Clarke HD, Scuderi GR. Minimal-incision total knee arthroplasty: the early clinical experience. Clin Orthop Relat Res 2005;440:67-76.

Juosponis R, Tarasevicius S, Smailys A, Kalesinskas RJ. Functional and radiological outcome after total knee re- placement performed with mini-midvastus or conven- tional arthrotomy: controlled randomised trial. Int Orthop 2009;33:1233-7.

Zhang Z, Zhu W, Gu B, Zhu L, Chen C. Mini-midvastus versus mini-medial parapatellar approach in total knee ar- throplasty: a prospective, randomized study. Arch Orthop Trauma Surg 2013;133:389-95.

Li XG, Tang TS, Qian ZL, Huang LX, Pan WM, Zhu RF. Comparison of the mini-midvastus with the mini-me- dial parapatellar approach in primary TKA. Orthopedics 2010;33:723.

Huang Z, Shen B, Ma J, Yang J, Zhou Z, Kang P, et al. Mini-midvastus versus medial parapatellar approach in TKA: muscle damage and inflammation markers. Ortho- pedics 2012;35:1038-45.

Lonner JH. Minimally invasive approaches to total knee arthroplasty: results. Am J Orthop (Belle Mead NJ) 2006;35(7 Suppl):27-9.

Heekin RD, Fokin AA. Mini-midvastus versus mini-medi- al parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium. J Ar- throplasty 2014;29:339-42.

Liu Z, Yang H. Comparison of the minimally invasive and standard medial parapatellar approaches for total knee ar- throplasty: systematic review and meta-analysis. J Int Med Res 2011;39:1607-17.

Aglietti P, Baldini A, Sensi L. Quadriceps-sparing versus mini-subvastus approach in total knee arthroplasty. Clin Orthop Relat Res 2006;452:106-11.

Kim YH, Sohn KS, Kim JS. Short-term results of primary total knee arthroplasties performed with a mini-incision or a standard incision. J Arthroplasty 2006;21:712-8.

Pietsch M, Djahani O, Hofmann S. Minimally invasive mini-midvastus approach as standard in total knee arthro- plasty. [Article in German] Orthopade 2007;36:1120-8. [Abstract]

Halder A, Beier A, Neumann W. Mini-subvastus approach for total knee replacement. [Article in German] Oper Or- thop Traumatol 2009;21:14-24.

Schroer WC, Diesfeld PJ, Reedy ME, LeMarr AR. Mini- subvastus approach for total knee arthroplasty. J Arthro- plasty 2008;23:19-25.

Gauvreau K, Pagano M. Student's t test. Nutrition 1993;9:386.

Wohlrab D, Zeh A, Mendel T, Hein W. Quadsparing approach in total knee arthroplasty. [Article in German] Oper Orthop Traumatol 2009;21:25-34. [Abstract]

Juosponis R, Tarasevicius S, Smailys A, Kalesinskas RJ. Functional and radiological outcome after total knee re- placement performed with mini-midvastus or conven- tional arthrotomy: controlled randomised trial. Int Orthop 2009;33:1233-7.

Nestor BJ, Toulson CE, Backus SI, Lyman SL, Foote KL, Windsor RE. Mini-midvastus vs standard medial parapa- tellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthro- plasty. J Arthroplasty 2010;25(6 Suppl):5-11, 11.e1.