title: [Systematic reviews of mini-invasive surgery versus standard approaches for total knee arthroplasty].
abstract: OBJECTIVE
  To conduct a systematic review to compare the early efficacies of minimally invasive surgery (MIS) versus conventional approaches in TKA (total knee arthroplasty).
  
  
  METHODS
  Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were retrieved from the databases of MEDLINE (1996.6 - 2010.12), EMBASE (1996.6 - 2010.12), PubMed (1996 - 2010.12) and Cochrane Library (Issue 2, 2012). Journal of Orthopedics (from establishment to December 2010) and Orthopedic Journal of China (from establishment to December 2010) were manually searched. Both RCTs and CCTs were included. The data were extracted by two reviewers with designed extraction form RevMan 4.2.8 software for data analysis. The criteria were as follows: (1) operative duration and reduced blood loss; (2) VAS (visual analog scale) score; (3) faster recovery of ROM (range of movement); (4) quadriceps muscle strength; (5) component positioning malalignment; (6) tibiofemoral angle; (7) rate of complications.
  
  
  RESULTS
  A total of 18 RCTs were included. Compared with the standard TKA procedure, the MIS group had a longer operative duration (WMD (weighted mean difference) 14.16, 95%CI (confidence interval) (12.61, 15.71)); reduced blood loss (WMD 8.31, 95%CI (6.16, 10.46)); lower VAS score at Days 3-5 post-operation (WMD 4.99, 95%CI (4.19, 5.78)); better Mean Knee Society scores at Week 6 post-operation (WMD 4.99, 95%CI (4.19, 5.78)), improvement in ROM occurred more rapidly at Month 3 post-TKA (WMD 14.59, 95%CI (8.39, 20.80)). Although the differences were not statistically significant, tibiofemoral angle was more precise in the standard group and the rate of component malalignment occurred more frequently in the MIS group (WMD 0.20, 95%CI (-0.12, 0.52)) (RR 1.57, 95%CI (0.88, 2.83)).
  
  
  CONCLUSIONS
  MIS leads to a faster recovery than conventional surgery with a shorter operative duration, a reduced blood loss, a lower VAS score and a faster recovery of ROM and quadriceps muscle strength. However, the rates of component malalignment and complications occur more frequently in the MIS group. Potential benefits in long-term survival rate and functional improvement require further investigations.
authors.affiliation: Department of Orthopedics, Fourth Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China.
authors.forename: Yu-cheng
authors.initials: YC
authors.lastname: Song
authors.forename: Rui
authors.initials: R
authors.lastname: Fang
authors.forename: Qing-cai
authors.initials: QC
authors.lastname: Meng
authors.forename: Heng
authors.initials: H
authors.lastname: Jia
authors.forename: Ying-jie
authors.initials: YJ
authors.lastname: Deng
authors.forename: Jun
authors.initials: J
authors.lastname: Liao
authors.forename: Han-gang
authors.initials: HG
authors.lastname: Hong
authors.forename: Xiao-qiang
authors.initials: XQ
authors.lastname: Ren
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D006801:Humans; D007720:Knee Prosthesis; D019060:Minimally Invasive Surgical Procedures; D016896:Treatment Outcome