title: Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique: A prospective, randomized, international multicentre trial.
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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02625311 8 December 2015.
authors.affiliation: Department Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. p.feczko@mumc.nl.
authors.forename: Peter
authors.initials: P
authors.lastname: Feczko
authors.affiliation: Heinrich-Braun-Krankenhaus Zwickau, Städtisches Klinikum, Zwickau, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Engelmann
authors.affiliation: Department Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
authors.forename: Jacobus J
authors.initials: JJ
authors.lastname: Arts
authors.affiliation: Repatriation General Hospital, Adelaide, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Campbell
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D010329:Patella / Q000601:surgery*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*