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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2017 | Review

Malalignment and malposition of quadriceps-sparing approach in primary total knee arthroplasty: a systematic review and meta-analysis

Authors: Fu-Zhen Yuan, Shao-Jie Wang, Zhu-Xing Zhou, Jia-Kuo Yu, Dong Jiang

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2017

Abstract

Background

Quadriceps-sparing (QS) approach is considered to be the most minimally invasive surgery for total knee arthroplasty (TKA). We perform this meta-analysis to evaluate whether malalignment and malposition are more biased towards the QS approach compared to the traditional medial parapatellar (MP) approach, which is still controversial.

Methods

According to the PRISMA guidelines, a comprehensive search was conducted in the databases of PubMed, the Cochrane library, and Embase. Relevant measures were extracted independently by two investigators.

Results

Five randomized controlled trials (RCTs) and eight retrospective studies including a total of 1261 cases were identified. The QS approach was associated with more outliers of hip-knee-ankle (HKA) angle (p = 0.03), coronal tibial component angle (p = 0.03), and femoral notch (p = 0.05). However, the differences of the outlier of the coronal femoral component angle between the two groups were not statistically significant.

Conclusions

This meta-analysis indicates that the QS approach is related to the high risk of malalignment and malposition. However, different studies reported different indicators resulting in small samples for analyzing the radiological outcomes. In addition, both of the relatively long learning curve and the present instruments might increase the risk of malalignment and malposition of the QS approach, which needs further study and improvement.

Kelly MA, Clarke HD. Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop Relat Res. 2002;404:51–7.CrossRef

Meftah M, White PB, Ranawat AS, Ranawat CS. Long-term results of total knee arthroplasty in young and active patients with posterior stabilized design. Knee. 2016;23:318–21.CrossRefPubMed

Bachmann M, Bolliger L, Ilchmann T, Clauss M. Long-term survival and radiological results of the Duracon total knee arthroplasty. Int Orthop. 2014;38:747–52.CrossRefPubMed

Pavone V, Boettner F, Fickert S, Sculco TP. Total condylar knee arthroplasty: a long-term follow up. Clin Orthop Relat Res. 2001;388:18–25.

Tria AJ, Coon TM. Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res. 2003;416:185–90.CrossRef

Tanavalee A, Thiengwittayaporn S, Itiravivong P. Results of the 136 consecutive minimally invasive total knee arthroplasties. J Med Assoc Thail. 2005;88(Suppl 4):S74–8.

Dalury DF, Dennis DA. Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res. 2005;440:77–81.CrossRefPubMed

Stulberg SD. Minimally invasive navigated knee surgery: an American perspective. Orthopedics. 2005;28:s1241–6.PubMed

Laskin RS. Minimally invasive total knee arthroplasty: the results justify its use. Clin Orthop Relat Res. 2005;440:54–9.CrossRefPubMed

10.

Goble EM, Justin DF. Minimally invasive total knee replacement: principles and technique. Orthop Clin North Am. 2004;35:235–45.CrossRefPubMed

11.

Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73:709–14.PubMed

12.

Bryan RS, Rand JA. Revision total knee arthroplasty. Clin Orthop Relat Res. 1982;170:116–22.

13.

Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res. 2005;433:152–9.CrossRef

14.

Floren M, Reichel H, Davis J, Laskin RS. The mini-incision mid-vastus approach for total knee arthroplasty. Oper Orthop Traumatol. 2008;20:534–43.CrossRefPubMed

15.

Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC, et al. Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res. 2004;428:74–81.CrossRef

16.

Insall J. A midline approach to the knee. J Bone Joint Surg Am. 1971;53:1584–6.CrossRefPubMed

17.

Higgins J, Thomas J, Churchill R, Lasserson T, Li TJ, Page M, et al. Cochrane Handbook for Systematic Reviews of Interventions.2017. http://handbook.cochrane.org/front_page.htm. Accessed 21 Mar 2017.

18.

Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefPubMedPubMedCentral

19.

Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 24 Mar 2017.

20.

Huang AB, Wang HJ, Yu JK, Yang B, Ma D, Zhang JY. Optimal patellar alignment with minimally invasive approaches in total knee arthroplasty after a minimum five year follow-up. Int Orthop. 2016;40:487–92.CrossRefPubMed

21.

Qi YS, Yang B, Yu JK, Zhang JY, Huang AB, Wang HJ. Does quadriceps-sparing total knee arthroplasty increase the risk of lower limb and component malalignment? A minimum 5-year follow-up study. Chin Med J. 2016;129:92–4.CrossRefPubMedPubMedCentral

22.

Chiang H, Lee CC, Lin WP, Jiang CC. Comparison of quadriceps-sparing minimally invasive and medial parapatellar total knee arthroplasty: a 2-year follow-up study. J Formos Med Assoc. 2012;111:698–704.CrossRefPubMed

23.

Yang JH, Yoon JR, Pandher DS, Oh KJ. Clinical and radiologic outcomes of contemporary 3 techniques of TKA. Orthopedics. 2010;33:76–81.CrossRefPubMed

24.

Karpman RR, Smith HL. Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty: a prospective, randomized study. J Arthroplast. 2009;24:681–8.CrossRef

25.

Chin PL, Foo LS, Yang KY, Yeo SJ, Lo NN. Randomized controlled trial comparing the radiologic outcomes of conventional and minimally invasive techniques for total knee arthroplasty. J Arthroplast. 2007;22:800–6.CrossRef

26.

Huang HT, Su JY, Chang JK, Chen CH, Wang GJ. The early clinical outcome of minimally invasive quadriceps-sparing total knee arthroplasty: report of a 2-year follow-up. J Arthroplast. 2007;22:1007–12.CrossRef

27.

Kim YH, Kim JS, Kim DY. Clinical outcome and rate of complications after primary total knee replacement performed with quadriceps-sparing or standard arthrotomy. J Bone Joint Surg Br. 2007;89:467–70.CrossRefPubMed

28.

King J, Stamper DL, Schaad DC, Leopold SS. Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty. Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am. 2007;89:1497–503.PubMed

29.

Shen H, Zhang XL, Wang Q, Shao JJ, Jiang Y. Minimally invasive total knee arthroplasty through a quadriceps sparing approach: a comparative study. Zhonghua Wai Ke Za Zhi. 2007;45:1083–6.PubMed

30.

Tashiro Y, Miura H, Matsuda S, Okazaki K, Iwamoto Y. Minimally invasive versus standard approach in total knee arthroplasty. Clin Orthop Relat Res. 2007;463:144–50.PubMed

31.

Chen AF, Alan RK, Redziniak DE, Tria AJ. Quadriceps sparing total knee replacement. The initial experience with results at two to four years. J Bone Joint Surg Br. 2006;88:1448–53.CrossRefPubMed

32.

Kim YH, Sohn KS, Kim JS. Short-term results of primary total knee arthroplasties performed with a mini-incision or a standard incision. J Arthroplast. 2006;21:712–8.CrossRef

Title: Malalignment and malposition of quadriceps-sparing approach in primary total knee arthroplasty: a systematic review and meta-analysis
Authors: Fu-Zhen Yuan
Shao-Jie Wang
Zhu-Xing Zhou
Jia-Kuo Yu
Dong Jiang
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2017
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-017-0627-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Malalignment and malposition of quadriceps-sparing approach in primary total knee arthroplasty: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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