Comparative study between computer assisted-navigation and conventional technique in minimally invasive surgery total knee arthroplasty, prospective control study. Minimally invasive total knee arthroplasty: surgical implications for recovery. Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study Simultaneous Bilateral MIS-TKA Results in Faster Functional Recovery Midterm outcomes of electromagnetic computer-assisted navigation in minimally invasive total knee arthroplasty Minimal invasive and computer-assisted total knee replacement compared with the minimal invasive technique: a prospective, randomized trial with short-term outcomes
BACKGROUND Both Minimally Invasive surgery ( MIS ) and Computer-Assisted Surgery ( CAS ) are useful in Total Knee Arthroplasty ( TKA ) . Minimally invasive total knee arthroplasty was associated with decreased blood loss , shorter hospital stays , and increased range of motion .  Computer-assisted surgery in total knee arthroplasty was developed to improve the positioning of implants during surgery . OBJECTIVE To evaluate radiographic results relative to component position and limb alignment when using a navigation system compared with conventional technique in MIS-TKA . MATERIAL AND METHOD A prospect i ve control study was performed in 180 patients who underwent total knee arthroplasty by one surgeon . All patients were r and omly divided into two groups , Conventional and Navigation TKA .  Intra- , post-operative data , and postoperative limb alignment were recorded for comparison in both groups . RESULTS The postoperative mechanical axis was within 3 degrees of neutral mechanical alignment in 94 % of the navigation group and 87 % in conventional group ( p = 0.13 ) . Registration time of navigation group is 13.58 minutes . No statistical significant difference was found in tourniquet time and postoperative blood loss in both groups . CONCLUSION The use of navigation in total knee arthroplasty increases accuracy in limb and implants alignment , and does not increase complications and surgical times BACKGROUND Despite growing interest in minimally invasive surgery ( MIS ) techniques for total knee arthroplasty ( TKA ) , few r and omized controlled trials have compared MIS and conventional TKA using a combination of functional performance , knee pain , knee range of motion ( ROM ) , and surgical and radiographic outcomes . METHODS A prospect i ve , r and omized investigation comparing early outcomes of TKA using conventional or MIS approaches  ( n = 44 ) . Patients were assessed preoperatively , 48 hours , 4 and 12 weeks postoperatively by blinded evaluators . Outcome measures included timed-up- and -go , 100-ft walk , knee pain , passive knee ROM , Knee Society Score , blood loss , tourniquet time , hospital length of stay , surgical complications , and radiographic outcomes . RESULTS No significant differences in functional performance , knee pain , knee ROM , surgical , or radiographic outcomes were observed between groups at 48 hours , 4 or 12 weeks postoperatively . CONCLUSION While surgical and radiographic outcomes were not compromised with MIS surgery , there were also no improvements in pain , ROM , or functional performance with MIS TKA 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 prospect i ve , r and omized , international multicentre trial including 69 patients was performed to compare computer-assisted TKA ( CAS-TKA ) using either mini-midvastus ( MIS group ) or st and ard medial parapatellar approach ( conventional group ) .  Patients from 3 centers ( Maastricht , Zwickau , Adelaide ) with end-stage osteoarthritis of the knee were r and omized 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 . Conclusion 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 . Trial registration number Clinical Trials.gov NCT02625311 8 December Purpose Whether minimally invasive total knee arthroplasty ( MIS-TKA ) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial . This prospect i ve and r and omized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA .  Methods Fifty patients , including 50 knees , who required TKA due to osteoarthritis were r and omized to the mini-subvastus group ( group I ) or the medial parapatellar group ( group II ) . All patients accepted the same method of anaesthesia , equal support therapy and identical rehabilitation exercise after surgery . The evaluation system included operation time , tourniquet time , blood loss , skin incision length in flexion , straight leg raising time , the time of lower limb muscle strength up to grade 4 , the time of walking with aid or without aid , the time of walking up and down the stairs , the active flexion angle , range of movement ( ROM ) , the Knee Society Scores ( KSS ) , visual analogue score for pain ( VAS ) , hospital stays and radiographic outcomes . Results The mini-subvastus approach offered smaller skin incision length in flexion , but at the cost of operation time ( P < 0.001 ) . No significant difference was found in tourniquet time and blood loss . The patients in group I could achieve straight leg raising , the lower limb muscle strength up to grade 4 , walking with or without aid , and walking up and down the stairs earlier ( P < 0.001 ) . The active flexion angle , ROM , VAS and KSS in group I were superior to those in group II until six months post-operatively ( P < 0.001 ) , but the differences was not apparent at 12 months post-operatively . More importantly , there was no significant difference between the two groups on radiological outcomes ( P > 0.05 ) . Conclusions The mini-subvastus approach could offer faster recovery , less pain and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the medial parapatellar approach Abstract Simultaneous bilateral TKAs subject patients to more arduous and painful functional recovery and increased risk of hemodynamic complications than staged bilateral TKAs . Minimally invasive TKA ( MIS-TKA ) reportedly results in more rapid return of function by limiting the amount of soft tissue disruption . We asked whether bilateral MIS-TKA had advantages over conventional TKA with respect to faster functional recovery . We prospect ively r and omized 30 patients into an MIS group ( mini-medial parapatellar approach , 15 patients ) and a conventional group ( conventional medial parapatellar approach , 15 patients ) . We recorded range of motion and the time required to regain the ability to walk without assistance . Functional recovery in the MIS group was faster in rehabilitation milestones of walking without assistance and gain in range of motion .  Minimally invasive TKA may benefit patients undergoing simultaneous bilateral procedures with faster functional recovery . Level of Evidence : Level II , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Background A combination of two emerging technologies , computer-assisted navigation and minimally invasive surgery , in total knee arthroplasty has gained increasing interests from orthopedic surgeons around the world . To date , there has never been any midterm study for clinical and radiographic outcomes from using an electromagnetic computer-assisted navigation system . In this study , we aim ed to systematic ally compare clinical and radiographic outcomes of minimally invasive surgery in total knee arthroplasty ( MIS-TKA ) performed with and without electromagnetic computer-assisted navigation at immediate and midterm follow-ups . Methods A total of 151 patients ( 160 knees ) who underwent MIS-TKA were r and omized to be operated with electromagnetic computer-assisted navigation ( group I : 75 patients , 80 knees ) or without the navigation ( group II : 76 patients , 80 knees ) . The clinical and radiographic outcomes of immediate , 6-week postoperative follow-up and average 6.1-year follow-up were compared . Results On immediate , 6-week postoperative follow-up , clinical and radiographic outcomes did not reveal any difference between the two groups except for the fact that the operative time was longer in the navigation group . On 6.1-year follow-up , a total of 58 patients ( 63 knees ) from group I and 58 patients ( 61 knees ) from group II were reevaluated . There were no significant differences in clinical and radiographic loosening and in complications between the two groups . Conclusion In this study , no significant differences of clinical and radiographic outcomes were found for immediate and midterm follow-ups of MIS-TKA performed with and without electromagnetic computer-assisted navigation except for the additional operating time in the navigation group Abstract Introduction Up to now , no prospect i ve , r and omized comparisons between minimal invasive and computer-assisted total knee arthroplasty ( MICA-TKA ) , and minimal invasive technique ( MI-TKA ) has been documented to evaluate not only clinical , but also radiologic results of the MICA-TKA . This prospect i ve , r and omized study was performed to compare the short-term results of MICA-TKA with minimal invasive technique MI-TKA for 6-month follow-up . Patients and methods We reported the clinical and radiological results of 80 subjects who had cruciate-substituting , TKA-implanted primary total knee arthroplasties using either minimal invasive and computer-assisted technique ( 40 patients Group I ) or minimal invasive technique ( 40 patients , Group II ) .  Tourniquet time , length of skin incision , and total blood loss were compared . Knee society scores ( KSSs ) , knee society functional scores ( KSFSs ) , range of motion ( ROM ) , and radiographic results were assessed and reported preoperatively and at 6-month follow-up . Results The accuracy of the implantations in relation to the coronal mechanical axis in Group I was superior to that of Group II ( P < 0.05 ) . The femoral rotational profile revealed the prosthesis in Group I that was implanted with significantly less internal rotation than in Group II . The average blood loss in patients of Group I was significantly reduced as compared to patients of Group II . No significant difference was detected in terms of tourniquet time or length of skin incision . Clinical results , with regard to ROMs and KSSs , as well as KSFSs were equally good in both the groups . Conclusions Better alignment and similarity of good clinical results at short-term follow-up may provide subjects who receive MICA-TKA with long-term endurance of their implants . Further studies on longer-term outcomes and functional improvements are required to vali date these possibilities
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 .
Computer-assisted minimally invasive TKA is superior than the st and ard MIS TKA in terms of component positioning ; however , it is unclear if this will have any long-term clinical implication s. The increased operative time , although clinical ly relevant , does not appear to be associated with an increase in complications
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 .