Long term results of total knee arthroplasty. The effect of surgical approach

Abstract

In total knee arthroplasty (TKA) “surgical technique” usually refers to the type of surgical approach and the technique utilized for osteotomies and ligament balancing. The conventional medial parapatellar approach has always been the workhorse when approaching the knee for TKA. The concept of minimally invasive surgery (MIS) was introduced in TKA following the MIS trend in many other surgical disciplines. The proposed advantages were less blood loss, less postoperative pain and opioid use, less hospitalization and faster functional recovery. At the same time the first reservations were expressed as MIS techniques were correlated with an increased risk of implant malalignment. Five principal surgical approaches are described, these are: The mini medial parapatellar, the quadriceps-sparing, the mini-midvastus, the mini-subvastus, and the direct lateral approach. Current evidence suggests that there is a modest advantage for MIS techniques during the first weeks or months. The scepticism about the malpositioning of the implants does not seem to be confirmed in these studies. Midterm or long term results are limited at the moment. © Springer-Verlag London 2015.