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Review
. 2021 Nov;29(11):3608-3620.
doi: 10.1007/s00167-020-06306-9. Epub 2020 Oct 6.

Better outcomes after minimally invasive surgeries compared to the standard invasive medial parapatellar approach for total knee arthroplasty: a meta-analysis

Filippo Migliorini  1 , Jörg Eschweiler  2 , Alice Baroncini  2 , Markus Tingart  2 , Nicola Maffulli  3   4   5
Affiliations
Review

Better outcomes after minimally invasive surgeries compared to the standard invasive medial parapatellar approach for total knee arthroplasty: a meta-analysis

Filippo Migliorini et al. Knee Surg Sports Traumatol Arthrosc. 2021 Nov.

Abstract

Purpose: Minimally invasive surgery (MIS) for total knee arthroplasty (TKA) is often marketed as being able to speed up healing times over standard invasive surgery (SIS) through the medial parapatellar approach. The advantages of these minimally invasive approaches, however, are not yet definitively established. A meta-analysis of studies comparing peri-operative and post-operative differences and long-term complications of MIS versus SIS for TKA was conducted.

Methods: This meta-analysis was conducted following the PRISMA guidelines. The Pubmed, Google Scholar, Scopus, and Embase databases were accessed in September 2020. All clinical trials comparing minimally-invasive versus standard approaches for TKA were considered. Only studies reporting quantitative data under the outcomes of interest were included. Methodological quality assessment was performed using the PEDro appraisal score.

Results: This meta-analysis covers a total of 38 studies (3296 procedures), with a mean 21.3 ± 24.3 months of follow-up. The MIS group had shorter hospitalization times, lower values of total estimated blood loss, quicker times of straight-leg raise, greater values for range of motion, higher scores on the Knee Society Clinical Rating System (KSS) and its related Function Subscale (KSFS). Pain scores, anterior knee pain and revision rate were similar between MIS and SIS. SIS allowed a quicker surgical duration.

Conclusion: The present meta-analysis encourages the use of minimally invasive techniques for total knee arthroplasty. However, MIS TKA is technically demanding and requires a long learning curve.

Level of evidence: III, meta-analysis of clinical trials.

Keywords: Minimally invasive surgery; Standard invasive surgery; Total knee arthroplasty.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow-chart of the literature search
Fig. 2
Fig. 2
Funnel plot of the most reported outcome, surgical duration
Fig. 3
Fig. 3
Forest plot of the comparison surgical duration
Fig. 4
Fig. 4
Forest plot of the comparison hospitalization length
Fig. 5
Fig. 5
Forest plot of the comparison range of motion
Fig. 6
Fig. 6
Forest plot of the comparison revision
See this image and copyright information in PMC

References

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