Does minimally invasive surgery improve short-term recovery in total knee arthroplasty?
BACKGROUND
Concerns have been raised regarding minimally invasive surgery (MIS) and its possible effect on postoperative functional recovery, complications, and survival rate after TKA.


OBJECTIVE
We specifically asked whether MIS TKA would be associated with (1) increased operative time, (2) reduced blood loss, (3) shortened hospital stay, (4) faster recovery of ROM, (5) higher knee scores, (6) inferior component positioning, and (7) increased complications.


METHODS
We performed a systematic literature search of randomized controlled trials between minimally invasive and standard approaches in TKA that compared operative time, blood loss, ROM, knee scores, component positioning, and complications. We conducted a systematic review and meta-analysis of 13 trials published from 2007 to 2009 of MIS versus standard TKA.


RESULTS
Patients in the MIS group had longer operating times (10-19 minutes). Mean Knee Society scores were better after MIS than after the standard procedure at 6 and 12 weeks postoperatively, but not after 6 months. Improvement in ROM occurred more rapidly in the MIS group 6 days after TKA but later improvements are not clearly documented. We identified no differences between minimally invasive and standard approaches regarding the short-term overall complications and alignment of femoral and tibial components. However, wound healing problems and infections occurred more frequently in the MIS group.


CONCLUSIONS
MIS leads to faster recovery than conventional surgery with similar rates of component malalignment but is associated with more frequent delayed wound healing and infections. Potential benefits in long-term survival rate and functional improvement require additional investigation. Level of Evidence Level II, therapeutic study (systematic review). See the Guidelines for Authors for a complete description of levels of evidence.
Cheng
Tao
T
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Liu
Tao
T
Zhang
Guoyou
G
Peng
Xiaochun
X
Zhang
Xianlong
X
D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008136:Longevity; D019060:Minimally Invasive Surgical Procedures; D016059:Range of Motion, Articular; D020127:Recovery of Function; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing