A Comparison of Short-Term Outcomes of Minimally Invasive Computer-Assisted vs Minimally Invasive Conventional Instrumentation for Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
BACKGROUND
Median parapatellar approach is the most used for total knee arthroplasty (TKA). With the advent of enhanced recovery and shorter length of hospital stay, there is an increasing pressure on surgeons to perform surgery through smaller incisions. Minimally invasive (MIS) TKA allows earlier functional recovery; it is not clear if this is associated with more complications. It is also unclear if computer-assisted minimally invasive (MIS CA) TKA has any affect on improving patient outcomes. We performed a systematic review and meta-analysis comparing MIS CA vs MIS TKA.


METHODS
We performed an extensive literature search including both randomized controlled studies and prospective cohort studies. All data reported on component alignment, surgical time, complications, knee flexion, and postoperative functional knee scores were included for analysis.


RESULTS
Ten studies were suitable for inclusion resulting in 490 patients with MIS CA and 503 MIS patients. There was no significant difference in the outliers on complications, knee flexion, and postoperative functional scores. Coronal plane tibial component showed statistically significant number of outliers in the MIS group demonstrating superior component positioning in the MIS CA group. Operative time was significantly longer in the MIS CA group with a mean increase of 32 minutes.


CONCLUSIONS
Computer-assisted minimally invasive TKA is superior than the standard MIS TKA in terms of component positioning; however, it is unclear if this will have any long-term clinical implications. The increased operative time, although clinically relevant, does not appear to be associated with an increase in complications.
York District General Hospital, York, UK.
Iihan A
IA
Alcelik
York District General Hospital, York, UK.
Mark I
MI
Blomfield
York District General Hospital, York, UK.
Givanni
G
Diana
York District General Hospital, York, UK.
Anthony J
AJ
Gibbon
York District General Hospital, York, UK.
Nick
N
Carrington
York District General Hospital, York, UK.
Stephen
S
Burr
D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D061646:Operative Time; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D013977:Tibia / Q000601:surgery
alignment; computer assisted; meta-analysis; minimally invasive; navigated; total knee arthroplasty