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Minimally Invasive Total Knee Arthroplasty Compared With Conventional Surgery

Joseph K. Lee, MD

Authors and Disclosures

Posted: 08/10/2010

A Prospective Randomized Study of Minimally Invasive Total Knee Arthroplasty Compared With Conventional Surgery

Wülker N, Lambermont JP, Sacchetti L, Lazaró JG, Nardi J
J Bone Joint Surg Am. 2010;92:1584-1590

Summary

Minimally invasive total knee arthroplasty has grown in popularity over recent years, but long-term data to support its use over traditional knee replacement surgery are lacking.^[1-4] Wülker and colleagues performed a multicenter study evaluating 134 patients undergoing total knee arthroplasty either by a standardized traditional technique or by a minimally invasive technique on the basis of total range of motion, Knee Society total and function scores, and visual analog scores for pain and activities of daily living.

Follow-up documented at hospital discharge, at 4 to 6 weeks, and then at 1 year after surgery showed no statistically significant difference in any of the outcomes. Furthermore, increased operative times and equivalent estimated blood loss were seen with the minimally invasive group.

Viewpoint

Although this study suggests that no significant benefit was seen in using a minimally invasive surgical technique over a standard traditional technique for total knee arthroplasty, the authors note that these results and their potential implications should be given careful consideration due to several issues.

For instance, the authors noted their study was underpowered because a power analysis was not performed before the study began. They also did not focus on quality-of-life outcomes (eg, length of hospital stay, reliance on pain medications, and the need for inpatient rehabilitation after discharge), which the minimally invasive approach is purported to show an advantage.

Larger, randomized prospective trials that incorporate other relevant metrics may help to delineate the benefits of one type of surgical technique over another. What may be also relevant to see, especially in this changing healthcare environment, is a cost-benefit analysis of a minimally invasive surgical technique compared with a traditional surgical approach.

According to disclosure statements, this study was partially funded by Smith & Nephew, which provided reimbursement only for case report form documentation to the study centers.