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Paper 211: Minimally Invasive Total Knee Arthroplasty: Comparison between Mini-subvastus and Limited-parapatellar Approach
ABSTRACTS
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assess component alignment and identify radiographic failures. One patient was lost to follow-up due to death at one year from an unrelated cause. The complications were stratified by each 100 cases performed to analyze the effects of the learning curve. Results: There was a total of 45 clinical complications (4.5%) identified. These complications included 25 manipulations, 12 arthroscopic procedures, and 6 polyethylene insert changes, and 2 component revisions. The rate of manipulations was 2.5% and did not differ from previous authors’ experiences in these cases. Four of the 12 arthroscopic procedure were undertaken for painful patellofemoral crepitus (mostly an initially non-visualized retained lateral band), and 8 of the 12 procedures for operative explorations for various component problems. There was one impending tibial component and one impending femoral component radiographic failure. Most of the operative complications (60%) occurred in the first 200 cases. Discussion: This study has yielded insights on potential improvements in performing total knee replacements with this minimally invasive technique. Minimally invasive techniques led to a very low complication rate. These rates were further improved as more surgery was performed since identifiable problems such as cement technique and need for examination of the lateral part of the knee were corrected. However, a major concern from this analysis was tibial component loosening (2 clinical, 1 radiographic), which may be related to decreased exposure and possibly poor cement pressurization. Further keel length reduction or modification may lead to improvement in component survival. The results of the study should allow for surgeons utilizing this technique to minimize their complication rates.
carried 5-6 cm in the quad tendon above the patella. In both series the patella was not everted. All knees were implanted with the same Legacy PS hi-flex prosthesis using a mini-keel tibial component, by the same surgeon with the same dedicated set of instruments. Both groups received a multimodal postoperative pain management. Results: Of the various objective parameters a significant difference was found in early quadriceps strength recovery, and flexion at 30 days in favor of the Mini-SV approach. Postoperative radiographic analysis showed no major outliers in both groups but some imperfections were found in the Mini-SV group (3 tibial component medialization, and 2 retained fragments of cement). The Mini-SV group had a higher DVT rate and a longer operative time.
Paper 211: Minimally Invasive Total Knee Arthroplasty: Comparison between Mini-subvastus and Limited-parapatellar Approach LORENZO SENSI, MD, ITALY, PRESENTING AUTHOR PAOLO AGLIETTI, MD, ITALY ANDREA BALDINI, MD, ITALY
Paper 212: The New Clinical Test for MIS QS Indication and the Comparison Between MIS QS and Mini Incision Quadriceps Split TKA SANG EUN PARK, MD, PHD, KOREA,
ABSTRACT Introduction: This matched case-control study compared early results of two groups of TKAs, performed using a Mini-SubVastus (Mini-SV) or a Limited ParaPatellar (LPP) approach. Methods: Preoperative parameters did not differ between the two groups. Exclusion criteria were: inflammatory arthritis, risk of skin ischemia, patella infera, restricted motion, morbid obesity, severe deformities (⬎20 degrees). In the LPP approach the incision was
LPP (# 50)
Mini-SV (# 50)
Tourniquet time (min.) 63 83 Total blood loss (ml) 811 833 Pain day one (VAS) 4.1 3.4 Active SLR (days) 1.9 1.6 90 degrees flexion (days) 2.5 2.1 Flexion at 30 days 99 degrees 109 degrees Distal DVT #2 #5
Significance P⬍0.05 n.s. n.s. p⬍0.05 p⬍0.05 p⬍0.05 p⬍0.05
Conclusions: In our opinion with the Mini-SV there were some minor early advantages (active SLR and flexion at 30 days). At three months no differences were detected and the type of approach did not influence the outcome. With the Limited Para-Patellar approach the exposure was easier throughout the surgical phases, thus decreasing the risk of surgical imperfections and allowing a more expeditious procedure.
ABSTRACT Introduction: Patient demand for a less invasive surgical approach reducing the trauma induced to the joint has resulted in the development of Minimally Invasive Surgery (MIS). Minimally invasive surgery for knee arthroplasty began in the late 1990s. Although the length of the surgical incision is appealing to patients, the changes are not purely cosmetic. The surgery should not violate the extensor mechanism in any way. Incisions into the quadriceps tendon or into the vastus medialis muscle make the approach less difficult but this violation will slow the recovery and affect the ROM of the knee. In Asian knees,
e297
assess component alignment and identify radiographic failures. One patient was lost to follow-up due to death at one year from an unrelated cause. The complications were stratified by each 100 cases performed to analyze the effects of the learning curve. Results: There was a total of 45 clinical complications (4.5%) identified. These complications included 25 manipulations, 12 arthroscopic procedures, and 6 polyethylene insert changes, and 2 component revisions. The rate of manipulations was 2.5% and did not differ from previous authors’ experiences in these cases. Four of the 12 arthroscopic procedure were undertaken for painful patellofemoral crepitus (mostly an initially non-visualized retained lateral band), and 8 of the 12 procedures for operative explorations for various component problems. There was one impending tibial component and one impending femoral component radiographic failure. Most of the operative complications (60%) occurred in the first 200 cases. Discussion: This study has yielded insights on potential improvements in performing total knee replacements with this minimally invasive technique. Minimally invasive techniques led to a very low complication rate. These rates were further improved as more surgery was performed since identifiable problems such as cement technique and need for examination of the lateral part of the knee were corrected. However, a major concern from this analysis was tibial component loosening (2 clinical, 1 radiographic), which may be related to decreased exposure and possibly poor cement pressurization. Further keel length reduction or modification may lead to improvement in component survival. The results of the study should allow for surgeons utilizing this technique to minimize their complication rates.
carried 5-6 cm in the quad tendon above the patella. In both series the patella was not everted. All knees were implanted with the same Legacy PS hi-flex prosthesis using a mini-keel tibial component, by the same surgeon with the same dedicated set of instruments. Both groups received a multimodal postoperative pain management. Results: Of the various objective parameters a significant difference was found in early quadriceps strength recovery, and flexion at 30 days in favor of the Mini-SV approach. Postoperative radiographic analysis showed no major outliers in both groups but some imperfections were found in the Mini-SV group (3 tibial component medialization, and 2 retained fragments of cement). The Mini-SV group had a higher DVT rate and a longer operative time.
Paper 211: Minimally Invasive Total Knee Arthroplasty: Comparison between Mini-subvastus and Limited-parapatellar Approach LORENZO SENSI, MD, ITALY, PRESENTING AUTHOR PAOLO AGLIETTI, MD, ITALY ANDREA BALDINI, MD, ITALY
Paper 212: The New Clinical Test for MIS QS Indication and the Comparison Between MIS QS and Mini Incision Quadriceps Split TKA SANG EUN PARK, MD, PHD, KOREA,
ABSTRACT Introduction: This matched case-control study compared early results of two groups of TKAs, performed using a Mini-SubVastus (Mini-SV) or a Limited ParaPatellar (LPP) approach. Methods: Preoperative parameters did not differ between the two groups. Exclusion criteria were: inflammatory arthritis, risk of skin ischemia, patella infera, restricted motion, morbid obesity, severe deformities (⬎20 degrees). In the LPP approach the incision was
LPP (# 50)
Mini-SV (# 50)
Tourniquet time (min.) 63 83 Total blood loss (ml) 811 833 Pain day one (VAS) 4.1 3.4 Active SLR (days) 1.9 1.6 90 degrees flexion (days) 2.5 2.1 Flexion at 30 days 99 degrees 109 degrees Distal DVT #2 #5
Significance P⬍0.05 n.s. n.s. p⬍0.05 p⬍0.05 p⬍0.05 p⬍0.05
Conclusions: In our opinion with the Mini-SV there were some minor early advantages (active SLR and flexion at 30 days). At three months no differences were detected and the type of approach did not influence the outcome. With the Limited Para-Patellar approach the exposure was easier throughout the surgical phases, thus decreasing the risk of surgical imperfections and allowing a more expeditious procedure.
ABSTRACT Introduction: Patient demand for a less invasive surgical approach reducing the trauma induced to the joint has resulted in the development of Minimally Invasive Surgery (MIS). Minimally invasive surgery for knee arthroplasty began in the late 1990s. Although the length of the surgical incision is appealing to patients, the changes are not purely cosmetic. The surgery should not violate the extensor mechanism in any way. Incisions into the quadriceps tendon or into the vastus medialis muscle make the approach less difficult but this violation will slow the recovery and affect the ROM of the knee. In Asian knees,