Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, 53127, Germany.
Department of Orthopedic and Trauma Surgery, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing 100091, China.
Technol Health Care. 2021;29(3):557-574. doi: 10.3233/THC-192078.
Minimally invasive total knee arthroplasty (TKA) has been actively advertised by the orthopedic industry. The purpose of this network meta-analysis was to comprehensively compare the effectiveness of four minimally invasive surgery (MIS) approaches and the medial parapatellar (MPP) approach to improve the American Knee Society Score (KSS) in primary TKA.
Studies were comprehensively searched on PubMed, Embase, Cochrane Library (CENTRAL), Web of Science and Science Direct up to June 2018 with a major focus on the outcome of KSS. Risk of bias was assessed using the Cochrane risk of bias tool. Quality assessment was performed using the GRADE system. Both pair-wise and network meta-analyses are calculated to comprehensively compare the effectiveness of four MIS and TKA approaches.
Eleven trials with 1025 knees undergoing TKA were included. Our analysis showed that both MPP and MIS approaches provided improvement in terms of short-term (four-eight weeks) total, objective and functional KSS. The network-meta analysis revealed that MIS approaches showed a trend towards superior KSS improvement over standard MPP approaches. However, statistical advantages were only observed in the mini-MPP group for functional KSS compared to the conventional MPP and quadriceps-sparing (QS) groups.
Evidence shows that MIS TKA approaches are effective alternatives to MPP approaches. However, orthopedic surgeons should be cautiously optimistic about minimally invasive TKA in terms of KSS improvement.
微创全膝关节置换术（TKA）已在骨科行业中得到积极推广。本网络荟萃分析的目的是全面比较四种微创外科（MIS）方法和内侧髌旁（MPP）入路对改善初次 TKA 美国膝关节协会评分（KSS）的效果。
我们全面检索了 PubMed、Embase、Cochrane 图书馆（CENTRAL）、Web of Science 和 Science Direct 上截至 2018 年 6 月的研究，主要关注 KSS 的结局。使用 Cochrane 偏倚风险工具评估偏倚风险。使用 GRADE 系统进行质量评估。进行了两两和网络荟萃分析，以全面比较四种 MIS 和 TKA 方法的效果。
纳入了 11 项涉及 1025 例 TKA 患者的试验。我们的分析表明，MPP 和 MIS 方法均能改善短期（4-8 周）总 KSS、客观 KSS 和功能 KSS。网络荟萃分析显示，MIS 方法在改善 KSS 方面优于标准 MPP 方法。然而，与常规 MPP 和股四头肌保留（QS）组相比，仅在迷你 MPP 组中，功能 KSS 具有统计学优势。
证据表明，MIS TKA 方法是 MPP 方法的有效替代方法。然而，在 KSS 改善方面，矫形外科医生应谨慎乐观地看待微创 TKA。
