Minimally invasive midvastus versus standard parapatellar approach in total knee arthroplasty: a meta-analysis of randomized controlled trials.
OBJECTIVE
Minimally invasive midvastus approach (mini-midvastus) has been widely used in total knee arthroplasty (TKA). However, the clinical effects still remains controversial. This meta-analysis was based on randomized controlled trials (RCTs) aiming to quantitatively analyze the clinical efficacy of mini-midvastus versus standard parapatellar approach in TKA.


METHODS
This meta-analysis was performed according to the PRISMA guidelines. A literature search for the eligible RCTs was carried out in the databases of PubMed, the Cochrane library, EMBASE and Web of Science. Two independent reviewers independently completed the study selection, data extraction, and the assessment of methodological quality. Meta-analysis was conducted by the RevMan 5.2 software.


RESULTS
A total of 18 RCTs (937 patients with 1093 TKAs) published from 2007 to 2013 were included. The meta-analysis suggested that the mini-midvastus approach significantly improved knee range of motion (ROM) and decreased visual analog score (VAS) at postoperative 1-2 weeks (p<0.05), and there were no statistical differences in terms of knee society score (KSS) (6 weeks to 1 year), VAS (6 weeks to 6 months), ROM (6 weeks to 6 months), lateral retinacular release, blood loss, straight leg raise, hospital stay and postoperative complications between the mini-midvastus and standard parapatellar approach (p>0.05). However, the operative time was significantly longer when performing the mini-midvastus group than the parapartellar approach (p<0.05).


CONCLUSIONS
This meta-analysis found that compared with the standard parapatellar approach, the mini-midvastus approach had early advantages in the VAS and ROM, but had the disadvantage in the operative time.


METHODS
Therapeutic study Level I.
Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China.
San-Zhong
SZ
Xu
Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China.
Xiang-Jin
XJ
Lin
Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China.
Xiang
X
Tong
Department of Orthopaedics, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China.
Xuan-Wei
XW
Wang
D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D039781:PubMed; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D013997:Time Factors