Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique: A prospective, randomized, international multicentre trial

Peter Feczko, Lutz Engelmann, Jacobus J Arts, David Campbell, Peter Feczko, Lutz Engelmann, Jacobus J Arts, David Campbell

Abstract

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 prospective, randomized, international multicentre trial including 69 patients was performed to compare computer-assisted TKA (CAS-TKA) using either mini-midvastus (MIS group) or standard medial parapatellar approach (conventional group). Patients from 3 centers (Maastricht, Zwickau, Adelaide) with end-stage osteoarthritis of the knee were randomized 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: ClinicalTrials.gov NCT02625311 8 December 2015.

Figures

Fig. 1
Fig. 1
Boxplot of the mechanical leg axis (degrees) for MIS and conventional TKA groups. The mean mechanical leg axis in the conventional group was 0.97° ± SD 1.87°, in the MIS group 0.54° ± SD 2.53°. 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)
Fig. 2
Fig. 2
Flexion/extension position of the femoral component. The flexion position in the conventional group was 1.94° ± SD 2.54°, in the MIS group 2.77° ± SD 2.09°. The difference between the two surgical groups was (‐0.83° (95 % CI ‐2.32 - 0.67); p = 0.27). Outliers are shown as dots
Fig. 3
Fig. 3
Rotational position of the femoral component. The rotational position in the conventional group was -1.00° ± SD 2.22°, in the MIS group -0.55° ± SD 2.74°. The difference between the two surgical groups was (‐0.45° (95 % CI ‐1.74 - 0.83); p = 0.49). Outliers are shown as dots
Fig. 4
Fig. 4
Varus/valgus position of the femoral component. The varus position in the conventional group was 0.71° ± SD 1.64°, in the MIS group 0.89° ± SD 1.68°. The difference between the two surgical groups was (‐0.18° (95 % CI ‐0.99 - 0.62); p = 0.65). Outliers are shown as dots
Fig. 5
Fig. 5
Varus/valgus position of the tibial component. The varus position in the conventional group was -0.97° ± SD 2.30°, in the MIS group -0.81° ± SD 2.25°. The difference between the two surgical groups was (‐0.16° (95 % CI ‐1.26 - 0.95); p = 0.78). Outliers are shown as dots
Fig. 6
Fig. 6
Posterior slope of the tibial component. The posterior slope in the conventional group was 4.63° ± SD 1.86°, in the MIS group 3.63° ± SD 2.61°. The difference between the two surgical groups was (1.00° (95 % CI ‐0.43 - 2.42); p = 0.16). Outliers are shown as dots

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