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Allows for quickest postoperative rehabilitation of any approach given sparing of quadriceps tendon
9%
48/522
Enables patients to re-establish normal gait patterns quicker post-operatively
6%
33/522
Allows for shorter tourniquet times and less post-operative pain
1%
7/522
Has not demonstrated clinically significant improvements in patient reported outcome scores
81%
425/522
Is not related to an increased risk of implant malalignment
6/522
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Patient reported outcome (PRO) scores have been demonstrated to be similar after total knee arthroplasty (TKA) when comparing minimally invasive, quadriceps sparing approaches to other standard TKA approaches such as the medial parapatellar approach. Minimally invasive approaches during TKA have become more popular over the last decade as it was originally suggested these approaches would improve TKA outcomes by sparing the quadriceps tendon attachment and preventing other soft tissue damage. One of the primary minimally invasive approaches referenced in the literature is the mini-subvastus approach, which preserves all four quadriceps attachments to the patella. However, since this time several studies have been published suggesting no significant improvements in post operative pain, rehabilitation protocols, or PROs. In contrast, concerns have developed regarding this approach and potential complications. Principally, this includes the risk for implant malalignment given the decrease in visualization seen during these minimally invasive approaches. Kazarian et al. performed a meta-analysis comparing quadriceps-sparing approaches to medial parapatellar approaches in TKA. They noted no clinically significant advantages in the less invasive exposures with regards to PROs, but did note an increase in outliers in femoral, tibial and mechanical axis alignment outliers. Interestingly, the surgical and tourniquet times were also increased for the minimally invasive approaches. Yuan et al. evaluated the issues of malalignment and component malpositioning in quadriceps-sparing TKAs. In their meta-analysis, they noted that the quadriceps-sparing approach was related to a high risk of implant malpositioning. They noted that there is a steep learning curve and instrumentation can be improved, but currently these approaches can lead to issues with implant positioning. Wegrzyn et al. performed a randomized controlled trial looking at the differences in minimally invasive TKA compared to a medial parapatellar approach in reference to gait and strength outcomes. They ultimately demonstrated no significant improvements in PROs, gait parameters or quadriceps strength in the minimally invasive group. They concluded that the minimally invasive approach does not confer a significant benefit in early function and is not recommended. Incorrect Answers: Answer 1: Rehabilitation protocols are similar when comparing minimally invasive, quadriceps sparing approaches to other standard TKA approaches with regards to range of motion and strengthening. Answer 2: Minimally invasive approaches did not demonstrate any significant improvement in gait parameters post-operatively. Answer 3: Tourniquet times have been shown to be longer with the minimally invasive approach and there is minimal evidence to suggest that patients have less pain. Answer 5: The risk of implant malalignment is increased with minimally invasive approaches given the lack of visualization.
4.0
(3)
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