title: Short Term Recovery of Function following Total Knee Arthroplasty: A Randomised Study of the Medial Parapatellar and Midvastus Approaches Mid-vastus vs medial para-patellar approach in total knee replacement--time to discharge. The Effect of Patella Eversion on Clinical Outcome Measures in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Minimally Invasive Subvastus Approach: Improving the Results of Total Knee Arthroplasty: A Prospective, Randomized Trial Mini-midvastus versus medial parapatellar approach in TKA: muscle damage and inflammation markers. Comparison of the subvastus and paramedian surgical approaches in bilateral knee arthroplasty. Mini-subvastus versus medial parapatellar approach for total knee arthroplasty: a prospective randomized controlled study Approach to Total Knee Replacement: A Randomized Double Blind Study between Medial Parapatellar and Midvastus Approach in the Early Postoperative Period in Asian Population Simultaneous Bilateral MIS-TKA Results in Faster Functional Recovery Better quadriceps recovery after minimally invasive total knee arthroplasty Functional and radiological outcome after total knee replacement performed with mini-midvastus or conventional arthrotomy: controlled randomised trial [Long-term analysis of minimally invasive surgery in knee arthroplasty]. Minimally invasive and computer-assisted total knee arthroplasty versus conventional technique: a prospective, randomized study Minimally invasive surgery (MIS) for total knee replacement; medium term results with minimum five year follow-up. Subvastus versus medial parapatellar approach in total knee arthroplasty A midvastus muscle-splitting approach for total knee arthroplasty. Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty: a prospective, randomized study. A prospective randomized study of minimally invasive total knee arthroplasty compared with conventional surgery. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Mini-midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty. The John Insall Award: No Benefit of Minimally Invasive TKA on Gait and Strength Outcomes: A Randomized Controlled Trial Quadriceps-sparing versus Mini-subvastus Approach in Total Knee Arthroplasty Five-year follow-up of minimally invasive computer assisted total knee arthroplasty (MICATKA) versus conventional computer assisted total knee arthroplasty (CATKA) - A population matched study. A comparison of subvastus and midvastus approaches in minimally invasive total knee arthroplasty. Total knee replacement performed with either a mini-midvastus or a standard approach: a prospective randomised clinical and radiological trial. Comparison of the mini-midvastus with the mini-medial parapatellar approach in primary TKA. Minimally invasive total knee arthroplasty improves early knee strength but not functional performance: a randomized controlled trial. Sub-vastus approach is more effective than a medial parapatellar approach in primary total knee arthroplasty: a randomized controlled trial. Is Obesity a Contraindication for Minimal Invasive Total Knee Replacement? A Prospective Randomized Control Trial Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA Minimally invasive total knee arthroplasty: surgical implications for recovery. Mini-subvastus versus a Standard Approach in Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study The effectiveness of minimally invasive total knee arthroplasty to preserve quadriceps strength: a randomized controlled trial. Quadriceps-sparing, minimal-incision total knee arthroplasty: a comparative study. Faster recovery after minimally invasive surgery in total knee arthroplasty Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium. Minimally Invasive Computer-Assisted Total Knee Arthroplasty Compared With Conventional Total Knee Arthroplasty: A Prospective 9-Year Follow-Up. Comparison of quadriceps-sparing minimally invasive and medial parapatellar total knee arthroplasty: a 2-year follow-up study. Differences between midvastus and subvastus TKA surgical approaches in the tasks of sitting and standing. Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?
abstract: This pilot double blind r and omised controlled study aim ed to investigate whether the midvastus ( MV ) approach without patellar eversion in total knee arthroplasty ( TKA ) result ed in improved recovery of function compared to the medial parapatellar ( MP ) approach . Patients were r and omly allocated to either the MV approach or the MP approach . Achievements of inpatient mobility milestones were recorded . Knee kinematics , muscle strength , Timed Up and Go , WOMAC , and daily step count were assessed before and up to six months after surgery . Cohen 's effect size d was calculated to inform the sample size in future trials . Twenty-eight participants ( 16 males , 12 females ) participated .  Patient mobility milestones such as straight leg raise were achieved on average 1.3 days ( 95 % CI −3.4 to 0.7 , d = 0.63 ) earlier in the MV group . Knee extensor strength at 6 weeks after surgery was higher ( 95 % CI −0.38 to 0.61 , d = 0.73 ) in the MV group . No trends for differences between the groups were observed in knee kinematics , TUG , WOMAC , or step count . Our results suggest a short term advantage in the first 6 weeks after surgery of the MV approach over the MP approach , but a larger study is required to confirm these findings . This trial is registered with NCT056445 BACKGROUND It has been shown before that when compared with the medial para-patellar approach , the mid-vastus approach for TKR results in less post-operative pain for patients and more rapid recovery of straight leg raise . As far as we are aware the post-operative length of stay of the two groups of patients has not been compared . We postulated that the reduced pain and more rapid recovery of straight leg raise would translate into an earlier , safe , discharge home for the mid-vastus patients compared with those who underwent a traditional medial para-patellar approach . METHODS Twenty patients operated on by each of five established knee arthroplasty surgeons were evaluated prospect ively with regard to their pre and post-operative range of movement , time to achieve straight leg raise post-operatively and length of post-operative hospital stay . Only one of the surgeons performed the mid-vastus approach , and the measurements were recorded by physiotherapists who were blinded as to the approach used on each patient . RESULTS The results were analysed using a st and ard statistical software package , and although the mean length of stay was lower for the mid-vastus patients , the difference did not reach a level of significance ( p = 0.13 ) . The time taken to achieve straight leg raise post-operatively was significantly less in the mid-vastus group ( p<0.001 ) . CONCLUSION Although this study confirms previous findings that the mid-vastus approach reduces the time taken for patients to achieve straight leg raise , when compared with the medial para-patellar approach , on its own it does not translate into a significantly shorter length of hospital stay . In order to reduce the length of post-operative hospital stay with an accelerated rehabilitation program for TKR , a multi-disciplinary approach is required . Patient expectations , GP support , physiotherapists and nursing staff all have a role to play and the mid-vastus approach , in permitting earlier straight leg raising , significantly contributes to this BACKGROUND During total knee arthroplasty ( TKA ) , surgical exposure requires mobilization technique of the patella . With this trial , we intended to investigate the effect of patella eversion on clinical outcome measures in simultaneous bilateral TKA . METHODS We prospect ively enrolled 44 patients ( 88 knees ) from April 2008 to June 20l4.One knee was operated with patella eversion  ( group A ) and the other with patella lateral retraction  ( group B ) r and omly . Follow-up results , including the operation time , complications , and the time of achieving straight leg raise ( SLR ) and 90 ° knee flexion , were recorded . The data of range of motion ( ROM ) and Visual Analogue Scale score were collected separately at 7 days , 3 months , 6 months , and 1 year postoperatively . RESULTS The time of achieving SLR was 2.7 ± 0.8 days in group A and 2.1 ± 0.7 DAYS in group B , which were significantly different ( P = .032 ) . Significant difference was found on active and passive ROM during the follow-up times between groups A and B , except the passive ROM at 6 months postoperatively . No significant difference was found on operation time , complications , patella baja or tilt , time of achieving 90 ° knee flexion , and Visual Analogue Scale score during the follow-up times . CONCLUSIONS Patellar eversion was adverse to the early knee function recovery after TKA ; it would delay the time of achieving SLR and decrease the passive and active ROM . In addition , more carefully and scientifically design ed r and omized controlled trials are still required to further prove the cl aim Background Minimally invasive knee arthroplasty seeks to diminish the problems of traditional extensile exposures aim ing for more rapid rehabilitation of patients after surgery . Questions / purpose s To determine if the subvastus approach results in less perioperative pain and blood loss , shorter hospital stay , and improved function at both early and long-term followup . Methods One hundred patients were enrolled in a prospect i ve , r and omized trial . Fifty were operated on using a minimally invasive subvastus approach and the other 50 by a conventional , peripatellar approach .  Minimum followup was 3 years . A repeated- measures analysis of variance was used to compare the Knee Society score and range of motion during followup . Results The minimally invasive approach result ed in greater perioperative bleeding but no increase in transfusions . No differences were found in postoperative pain between groups nor did hospital stay show any differences . The range of motion on the third day after surgery was greater in the minimally invasive group . No differences were found in surgical time , femoral or tibial component orientation or outliers , or complication rates . Both Knee Society score and range of motion were superior using the minimally invasive subvastus approach during followup out to 36 months . Conclusions The minimally invasive subvastus approach can result in improved long-term Knee Society scores and range of motion of total knee arthroplasty without increased risk of component malalignment , surgical time , or complication rate . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence The purpose of this prospect i ve study was to analyze the biochemical markers of muscle damage and inflammation in patients treated with the mini-midvastus approach or the medial parapatellar approach for total knee arthroplasty . Of 60 patients who underwent unilateral total knee arthroplasty , 30 were treated with the mini-midvastus approach ( MMV group ) and 30 were treated with the  medial parapatellar approach ( MPP group ) . Serum creatine kinase , myoglobin , lactate dehydrogenase , glutamic oxaloacetic transaminase , C-reactive protein , interleukin-6 , and interleukin-1β levels were measured preoperatively , immediately postoperatively ( except for C-reactive protein level ) , and on postoperative days 1 , 2 , and 3 . Student 's t test , Pearson 's chi-square test , and Fisher 's exact test were used to compare the outcomes between the 2 groups . Compared with the MPP group , a significant increase in serum creatine kinase level existed in the MMV group on postoperative days 2 ( P=.08 ) and 3 ( P=.09 ) and cumulatively ( P=.02 ) . However , significantly elevated C-reactive protein and interleukin-6 levels existed in the MPP group . According to the serum creatine kinase levels , the mini-midvastus approach has no superiority over the medial parapatellar approach in terms of sparing muscle and may cause more muscle damage . Further study is warranted to determine the correlation between biochemical markers and functional deficits A prospect i ve r and omized study was performed on 20 patients undergoing one-stage bilateral knee arthroplasty . One knee was exposed using a st and ard median parapatellar arthrotomy and the other knee with a subvastus arthrotomy . All patients underwent quantitative strength testing before surgery and at 1 week , 1 month , and 3 months after surgery . The knees were also evaluated for range of motion , and patients , who were blinded as to the approach used , completed question naires at each evaluation period as to their preference , if any , regarding knee pain and level of function . There was no difference in the range of motion between knees exposed with the paramedian or subvastus arthrotomy at any time period . The subvastus knees demonstrated significantly greater strength at the 1-week and 1-month intervals , but there was no strength difference at the 3-month interval . There were more lateral releases performed in the paramedium knees , and three minor complications were related to the subvastus approach . Patients who expressed a preference chose the subvastus knee 4:1 over the paramedian knee . The subvastus approach offers a reasonable alternative to the paramedian arthrotomy and preserves greater quadriceps strength in the early postoperative period Purpose Whether minimally invasive total knee arthroplasty ( MIS-TKA ) could offer better and faster recovery without the deviation of post-operative prosthesis position and limb alignment is still controversial . This prospect i ve and r and omized study was conducted to compare the clinical and radiological outcomes between patients who underwent the mini-subvastus approach of MIS-TKA and those who underwent the medial parapatellar approach of traditional TKA .  Methods Fifty patients , including 50 knees , who required TKA due to osteoarthritis were r and omized to the mini-subvastus group ( group I ) or the medial parapatellar group ( group II ) . All patients accepted the same method of anaesthesia , equal support therapy and identical rehabilitation exercise after surgery . The evaluation system included operation time , tourniquet time , blood loss , skin incision length in flexion , straight leg raising time , the time of lower limb muscle strength up to grade 4 , the time of walking with aid or without aid , the time of walking up and down the stairs , the active flexion angle , range of movement ( ROM ) , the Knee Society Scores ( KSS ) , visual analogue score for pain ( VAS ) , hospital stays and radiographic outcomes . Results The mini-subvastus approach offered smaller skin incision length in flexion , but at the cost of operation time ( P < 0.001 ) . No significant difference was found in tourniquet time and blood loss . The patients in group I could achieve straight leg raising , the lower limb muscle strength up to grade 4 , walking with or without aid , and walking up and down the stairs earlier ( P < 0.001 ) . The active flexion angle , ROM , VAS and KSS in group I were superior to those in group II until six months post-operatively ( P < 0.001 ) , but the differences was not apparent at 12 months post-operatively . More importantly , there was no significant difference between the two groups on radiological outcomes ( P > 0.05 ) . Conclusions The mini-subvastus approach could offer faster recovery , less pain and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the medial parapatellar approach & NA ; The purpose of this r and omized study was to compare clinical and surgical outcomes of total knee replacements ( TKRs ) in the early postoperative period using midvastus approach versus medial parapatellar approach in Asian population in a double blind manner . Forty‐two knees each were operated using midvastus approach and the medial parapatellar approach .  Clinical parameters that were evaluated included Knee Society score ( KSS ) ; knee pain using visual analogue scale ( VAS ) on day 1 , 1 week , and 1 month ; time required to straight leg raise ( SLR ) ; patellar tracking ; mean extensor lag at 1 week and 1 month ; and time of discharge from the hospital . Surgical parameters that were evaluated included tourniquet time , incidence of lateral retinacular release , estimated blood loss , and any complications during the surgery . KSS at 1 week and 1 month postoperatively were significantly higher in the midvastus group as compared with medial parapatellar group ; though similar at 3 months , 6 months , and 1 year . The patients in midvastus group required fewer number of lateral retinacular releases ; achieved SLR earlier ; had less mean extensor lag at 1 week ; had less mean VAS score at day 1 , 1 week , and 1 month ; and had shorter hospital stay . There was no significant difference in the mean tourniquet time and estimated blood loss . One patient had patellar maltracking in the medial parapatellar group as compared with none in midvastus group . Midvastus approach to TKR results in quicker functional recovery with early discharge and rehabilitation in the Asian population as compared with medial parapatellar approach Abstract Simultaneous bilateral TKAs subject patients to more arduous and painful functional recovery and increased risk of hemodynamic complications than staged bilateral TKAs . Minimally invasive TKA ( MIS-TKA ) reportedly results in more rapid return of function by limiting the amount of soft tissue disruption . We asked whether bilateral MIS-TKA had advantages over conventional TKA with respect to faster functional recovery . We prospect ively r and omized 30 patients into an MIS group ( mini-medial parapatellar approach , 15 patients ) and a conventional group ( conventional medial parapatellar approach , 15 patients ) . We recorded range of motion and the time required to regain the ability to walk without assistance . Functional recovery in the MIS group was faster in rehabilitation milestones of walking without assistance and gain in range of motion .  Minimally invasive TKA may benefit patients undergoing simultaneous bilateral procedures with faster functional recovery . Level of Evidence : Level II , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Purpose The proponents of  minimally invasive total knee arthroplasty ( TKA )  have reported better functional recovery than conventional TKA . In most of the previous studies , the results were shown with the relatively subjective methods . We investigated the objective results with a dynamometry in this prospect i ve r and omized study . It was hypothesized that minimally invasive TKA would have a better and earlier recovery of quadriceps force in terms of the objective numeric data . Methods Sixty-six TKAs were prospect ively r and omized into two groups . Thirty-three knees underwent minimally invasive TKA using mini-midvastus approach and 33 knees underwent conventional TKA using medial parapatellar approach .  The quadriceps force was assessed using a dynamometer . The data were collected preoperatively and at postoperative 6 weeks , 3 months , 6 months and 1 year consecutively . Results The mean of quadriceps force in minimally invasive TKA group at postoperative 6 weeks was greater than conventional TKA after removing the covariate ( preoperative quadriceps force ) with analysis of covariance ( P = 0.002 ) , but thereafter , the difference was not significant till 1 year . Meanwhile , with repeated measures analysis of variance , conventional TKA group had greater quadriceps recovery than minimally invasive TKA group during postoperative 6 weeks to 3 months ( P = 0.035 ) . The proportion of patients unable to recover the quadriceps force to their preoperative levels by 1 year postoperatively was similar in two groups . Conclusion Minimally invasive TKA has benefit in quadriceps recovery at earlier rehabilitation period although catch-up recovery in conventional TKA was accelerated from the postoperative 6 weeks to 3 months . It may support the concept of early return to full activity after minimally invasive TKA , and patients might get back early to normal life . Level of evidence Therapeutic study , Level The results of minimally invasive techniques used for total knee replacement are controversial . Despite reported advantages such as faster recovery , there are some concerns regarding component positioning . We compared mini-midvastus versus medial parapatellar arthrotomy with respect to component position and functional results . We included 70 osteoarthritis total knee replacement patients in our study . Patients were r and omised for the approach . We recorded Knee Society scores before and after the surgery and radiological component position . Patients were followed up to 12 weeks after the surgery . We found that the mini-midvastus approach was associated with better Knee Society scores six weeks after surgery ; after 12 weeks the difference was not statistically significant . We found no difference related to the approach in radiological component position . The mini-midvastus approach is associated with faster recovery and reproduces the same accuracy in component positioning as the medial parapatellar approach . RésuméLes techniques de chirurgie mini-invasives sont controversées dans les prothèses totales du genou . En dépit d’une récupération plus rapide , il est nécessaire de bien observer la position des implants . Nous avons comparé un abord mini-midvastus versus à un abord parapatellaire médian sur les critères position des implants et sur les résultats fonctionnels . Matériel et méthode : 70 approches du genou avec remplacement total ont été étudiés . Les patients ont été r and omisés selon la voie d’abord . Le score de la Knee Society et l’étude radiologique ont permis l’évaluation de ces prothèses . Les patients ont été suivis 12 semaines après l’intervention chirurgicale . Résultats : nous avons trouvé que l’abord mini-midvastus était associé à un meilleur score fonctionnel 6 semaines après l’intervention . Après 12 semaines , la différence n’est pas statistiquement significative . Nous n’avons pas trouvé de différence en ce qui concerne la position des implants . En conclusion : l’abord mini-midvastus est associé à une récupération plus rapide et , permet de positionner les implants de façon aussi efficace que lors d’un abord parapatellaire médian BACKGROUND Knee arthroplasty is the treatment of choice for gonarthrosis .  The development of minimally invasive surgery ( MIS ) requires assessing results based on the classical approaches and this is the purpose of our study . METHODS R and omized , prospect i ve study comparing two groups ; one underwent MIS ( 45 patients ) and the second one a classical approach ( 51 patients ) ; both groups were comparable . The following variables were assessed in the immediate postoperative period and at 4 and 8 years : blood loss , pain according to the VAS , flexion and extension and quality of life measured with the SF-36 . RESULTS In the immediate postoperative period we observed statistically significant differences ( p < 0.05 ) in favor of the MIS approach in pain , hospital stay and blood loss . However , this was not observed at 4 and 8 years concerning pain , quality of life and range of motion . We observed an improvement in the functional scale and quality of life compared with the preoperative status , without any differences when both groups were compared . CONCLUSIONS The MIS technique results in a better immediate postoperative period , but no differences were seen in the choice of the approach 4 and 8 years after surgery We conducted a prospect i ve , r and omized study to compare the short-term results of minimally invasive and computer-assisted total knee arthroplasty ( MICA-TKA ) with those of conventional total knee arthroplasty ( C-TKA ) for 12-month follow-up . A total of 87 subjects who met the inclusion and exclusion criteria of the study were prospect ively r and omized consecutively into two groups : the C-TKA group ( Group A , n = 44 ) and the MICA-TKA technique ( Group B , n = 43 ) . All the operations were performed by the same senior surgeon . Before surgery and at follow-up , patients were evaluated by the same observer . Tourniquet time as well as total blood loss was compared . Knee Society scores ( KSSs ) , Knee Society functional scores ( KSFSs ) , range of motion ( ROM ) , and radiographic results were assessed and reported preoperatively and at 12-month follow-up . Of these patients , 82 ( Group A 42 ; Group B 40 ) were available for 12-month evaluation . The two groups were found to be similar in terms of coronal mechanical axis . Similarly , the femoral rotational profile revealed that the prosthesis in Group A was implanted with similar internal rotation to Group B. The average blood loss in patients of Group B was significantly reduced as compared to patients of Group A. No significant difference was detected in terms of tourniquet time . Clinical results in Group B , with regard to ROMs and KSSs , as well as KSFSs were significantly superior to that in Group A. Based on the results obtained from this study , it is demonstrated that MICA-TKA leads to a similarly accurate restoration of leg alignment and component orientation compared to the C-TKA . Moreover , MICA-TKA produces superior clinical results to that of C-TKA . However , there is clearly a need for additional high- quality clinical trials with long-term follow-up to confirm the clinical benefits of MICA-TKA BACKGROUND MIS TKA has been shown to offer a reduced in-patient stay , but no clinical difference at two years . Whilst there may be a benefit from earlier discharge , we need to ensure that there are no detrimental effects in the medium and long-term following MIS-TKA . To report the mid-term result from a prospect i ve r and omised controlled trial ( RCT ) comparing MIS-TKA with st and ard approach for TKA . METHODS Using knee score question naires , we collected patient reported outcome measures ( PROMs ) regarding pain and function .  Sixty-six patients ( from an eligible cohort of 83 patients ) completed the mid-term postal follow-up . RESULTS There was no significant difference between groups for change in score from pre-operative to final follow-up in all three PROMs . Mean MIS and st and ard group improvement was : AKSS 53 and 51 ( p=0.7644 ) , OKS 15 and 16 ( p=0.2341 ) or WOMAC 15 and 15 ( p=0.9900 ) respectively . Both groups showed improvement in pain and function with no significant difference between groups . There was no difference between groups for revision due to malalignment at a mean six year follow-up . CONCLUSIONS In addition to the early benefits regarding hospital stay and complications , we have found that at a mean of six years there was no increase in malalignment , pain or function with MIS techniques Abstract . The subvastus approach for total knee replacement was compared with the st and ard medial parapatellar approach in terms of postoperative knee scores and quadriceps strength . Two groups of patients with similar characteristics were formed : the first group consisted of 12 knees of 9 patients who were implanted via the medial parapatellar approach , and for the second group the subvastus approach was used in 10 knees of 10 patients . The groups ' knee scores and quadriceps strength were compared preoperatively and postoperatively at week 6 , months 3 and 6 . The knee scores improved similarly in both groups , but the change was more pronounced in the subvastus group . Quadriceps strength was greater in the subvastus group at postoperative week 6 , but there was no significant difference between the groups in months 3 and 6 . It was concluded that although the subvastus approach offers greater quadriceps strength in the early postoperative period , it has no significant advantage in this aspect over the medial parapatellar approach This study presents a modification of the medial parapatellar surgical approach for total knee arthroplasty . This approach separates the vastus medialis muscle in the direction of its fibers beginning at the superior pole of the patella . One hundred eighteen consecutive total knee arthroplasty cases , performed by a single surgeon , were r and omized prospect ively to receive a medial parapatellar or midvastus muscle-splitting surgical approach . The frequency of lateral retinacular releases was recorded , patellar tilt and translation were measured , and quadriceps strength was tested . The midvastus muscle-splitting approach provided excellent exposure to all knees . Patellar stability and quadriceps strength were equivalent for the two approaches . It is concluded that the midvastus muscle-splitting approach is an efficacious alternative to the medial parapatellar approach for primary total knee arthroplasties A prospect i ve , r and omized study was performed to compare early clinical and radiographic outcomes of total knee arthroplasty using either st and ard or minimally invasive surgical approaches . Fifty-nine patients were r and omized into 3 groups : a st and ard median parapatellar incision ( n = 19 ) , a " mini mid-vastus " ( n = 20 ) , or a " quad sparing " group ( n = 20 ) . The procedures were performed by a single surgeon using similar perioperative protocol s at 1 hospital . Postoperatively , the quad sparing group demonstrated some statistically significant ( P < .05 ) improvement in week 2 and greater but not in weeks 1 and 6 compared to the other groups . No significant differences occurred regarding postoperative complications or radiographic alignment of the implants . In conclusion , our study demonstrated that the quad sparing group had some improved early results without compromising safety or efficacy BACKGROUND Despite intense debate regarding whether minimally invasive techniques for total knee arthroplasty improve clinical outcomes over st and ard techniques , few prospect i ve r and omized trials addressing this debate are available in the literature . We therefore design ed this multicenter study to assess the overall safety and effectiveness of a minimally invasive approach without the use of computer navigation in comparison with conventional knee arthroplasty . METHODS We prospect ively r and omized 134 patients ( 101 women and thirty-three men , with an average age of 70.1 years ) to undergo surgery for total knee arthroplasty with use of either minimally invasive knee instruments ( sixty-six patients ) or a st and ard approach ( sixty-eight patients ) . The follow-up period was one year . RESULTS On the basis of our sample size , no significant difference was detected between the groups in any of the relevant clinical areas assessed : total range of motion , Knee Society total and function scores , and visual analog scores for pain and activities of daily living . Patients who underwent minimally invasive surgery had a longer mean surgical time ( by 5.6 minutes ) and had less mean blood loss ( by 17 mL ) . Radiographic measurements demonstrated reliable implant positioning in both groups . Seven patients in each group had an adverse event related to their procedure . CONCLUSIONS On the basis of the numbers , no significant advantage to minimally invasive total knee arthroplasty over a conventional technique was observed . Greater sample sizes and a longer follow-up period are required to fully determine the long-term safety and efficacy of this minimally invasive surgical technique QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis The purpose of this study was to determine whether the mini-midvastus approach to total knee arthroplasty ( TKA ) results in differences in quadriceps muscle strength as well as previously cited advantages in a double blind prospect i ve r and omized trial . Twenty-seven patients ( 54 TKAs ) scheduled for bilateral TKA were r and omized to undergo mini-midvastus approach on one knee and st and ard approach on the other . Incision lengths were the same . Postoperative strength was determined by isokinetic and isometric peak torque testing . Range of motion , pain Visual analog scale , side-preference , and gait analysis were assessed preoperatively and postoperatively . The only significant difference in strength testing was increased isokinetic and isometric extension torque at 3 weeks postoperatively for the mini-midvastus approach . No differences between the mini-midvastus and st and ard approach were observed for stride length , stance time , pain Visual analog scale , or knee range of motion . The mini-midvastus approach has limited benefit compared to the st and ard approach for TKA Background While some clinical reports suggest minimally invasive surgical ( MIS ) techniques improve recovery and reduce pain in the first months after TKA , it is unclear whether it improves gait and thigh muscle strength . Questions / Purpose sWe hypothesized TKA performed through a mini-subvastus approach would improve subjective and objective and subjective function compared to a st and ard medial parapatellar approach 2 months after surgery . Methods We r and omized 40 patients into two groups using either the mini-subvastus approach or st and ard medial parapatellar approach .  Patients were evaluated preoperatively and 2 months after surgery . We assessed subjective functional outcome and quality of life ( QOL ) using routine question naires ( SF-12 , Knee Society Score [ KSS ] , Knee Injury and Osteoarthritis Outcome Score [ KOOS ] , UCLA activity , patient milestone diary of activities ) . We determined isometric strength of the thigh muscles and assessed gait with a three-dimensional ( 3-D ) analysis during level walking and stair climbing . Results We observed improvements from preoperatively to 2 months postoperatively in functional scores , QOL , and knee kinematic and kinetic gait parameters during level and stair walking . Isometric quadriceps strength increased in both groups , although remaining lower when compared to sound limbs . We found no differences between the groups in KSS , SF-12 , KOOS , UCLA activity , patient milestone diary of activities , isometric quadriceps strength , or 3-D gait parameters , except a marginally higher speed of stair ascent in the MIS group . Conclusions Our observations suggest an MIS approach does not confer a substantial advantage in early function after TKA.Level of Evidence Level I , therapeutic study . See Instructions to Authors for a complete description of levels of evidence In a prospect i ve r and omized double-blind study we compared the postoperative recovery and early results of two groups of 30 patients having total knee arthroplasty with minimally invasive techniques using either a mini-subvastus or a modified “ quadriceps-sparing ” approach .  All knees were implanted with the same posterior-stabilized prosthesis ( LPS-Flex , Zimmer , Warsaw , IN ) by the same surgeon with the same dedicated set of downsized instruments . Epidural anesthesia with the same postoperative analgesia and rehabilitation protocol was used in all patients . Evaluation was performed preoperatively , postoperatively in the first week , and at 1 and 3 months . In five cases in the “ quadriceps- sparing ” group , the incision was extended a few cm to facilitate exposure . Tourniquet time , estimated blood loss , and postoperative pain were similar in the two groups . Active straight leg raising was achieved half a day earlier , on average , in the mini-subvastus group ( 1.9 vs 1.4 days ) . Average maximum active flexion was similar in the two groups at each interval , and reached 117 ° and 119 ° at 3 months for the mini-subvastus and “ quadriceps-sparing ” group , respectively . We believe there was no difference between the mini- subvastus and “ quadriceps-sparing ” approach in relation to short term recovery or early results . Level of Evidence : Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND Minimally invasive surgery ( MIS ) has perceived advantages in the early post-operative stage such as reduced blood loss , decreased pain , earlier return to function and earlier discharge . The aim of our study was to confirm that longer term clinical outcome of TKA is not compromised when MIS is combined with computer assisted surgery . METHODS Eighty patients matched for age , gender , pre-operative Knee Society Score ( KSS ) and mechanical axis were prospect ively studied . Forty patients underwent minimally invasive computer assisted total knee arthroplasty ( MICATKA ) and 40 patients underwent conventional computer assisted TKA ( CATKA ) .  Functional scores were determined at 6 weeks , 6 , 12 , 18 , and 24 months and 5 years post-surgery . Long-leg alignment views were obtained 3 months post-operatively . RESULTS KSSs in the short term were significantly better in the MICATKA group than in the CATKA group ( p<000.1 ) . Tourniquet-time was 58 min in the MICTKA group and 60 min in the CATKA group ( p=0.3 ) . Straight leg raise was achieved by day one in 93 % of the MICATKA group compared to 30 % of the CATKA group ( p<0.001 ) . Length of stay for the MICATKA group has a mean of 3.25 days and a mean of 6 days for the CATKA group ( p<0.001 ) . KSSs up to 2-years were significantly better in the MICTKA group ( p<0.001 ) . At 5-years there was no significant difference in KSSs ( p=0.46 ) in the MICATKA and CATKA groups . CONCLUSION We confirm that the use of navigation in minimally invasive TKA permits a number of early post-operative advantages and that longer-term functional outcome is not compromised with its usage . LEVEL OF EVIDENCE Level II BACKGROUND The mini-subvastus and the mini-midvastus approaches are among the most common alternatives to the medial parapatellar approach for total knee arthroplasty . The purpose of this study was to compare the early clinical outcomes of these two approaches . METHODS In this prospect i ve , r and omized study of fifty-one patients who underwent bilateral total knee arthroplasty , the mini-subvastus approach was used in one knee and the mini-midvastus approach , in the contralateral knee . There were forty-two women and nine men who had a mean age of seventy years at the time of the index arthroplasties , and they were followed for two years postoperatively . Clinical outcome was assessed and compared with use of the Knee Society pain and function scores , the straight-leg-raising test , range of motion , and isokinetic strength testing . Operating time and blood loss for each approach were also compared . In addition , patients were surveyed concerning which knee they preferred . RESULTS Comparisons of postoperative Knee Society scores between both approaches at the time of the two-year follow-up did not yield a significant difference in outcome . Isokinetic strength testing at twelve weeks postoperatively revealed no significant differences in muscle strength , with a mean extensor peak torque-to-body weight ratio of 0.14 Nm/kg for both groups . No significant difference was found with respect to total blood loss , straight-leg-raising test , range of motion , or patient preference . There was no clinical ly relevant difference in operative times between the two approaches . CONCLUSIONS The minimally invasive subvastus and midvastus approaches for total knee arthroplasty were both associated with excellent short-term clinical results . Some surgeons believe that the subvastus approach completely avoids damage to the quadriceps mechanism and therefore would be associated with improved muscle function . This prospect i ve series did not identify a substantive difference between the two approaches . We believe that the decision between these surgical approaches should be based on surgeon preference and experience We report the clinical and radiological results of a two- to three-year prospect i ve r and omised study which was design ed to compare a minimally-invasive technique with a st and ard technique in  total knee replacement  and was undertaken between January 2004 and May 2007 . The  mini-midvastus approach was used on 50 patients ( group A ) and a st and ard approach on 50 patients ( group B ) . The mean follow-up in both groups was 23 months ( 24 to 35 ) . The functional outcome was better in group A up to nine months after operation , as shown by statistically significant differences in the mean function score , mean total score and the mean Oxford knee score ( all , p = 0.05 ) . Patients in group A had statistically significant greater early flexion ( p = 0.04 ) and reached their greatest mean knee flexion of 126.5 degrees ( 95 degrees to 135 degrees ) 21 days after operation . However , at final follow-up there was no significant difference in the mean maximum flexion between the groups ( p = 0.08 ) . Technical errors were identified in six patients from group A ( 12 % ) on radiological evaluation . Based on these results , the authors currently use minimally-invasive techniques in total knee replacement in selected cases only A prospect i ve r and omized study was performed to compare the clinical and radiological results of primary total knee arthroplasties ( TKAs ) using a mini-midvastus approach or a mini-medial parapatellar approach in 134 patients . The mini-midvastus approach was used on 68 patients ( group A ) and the mini-medial parapatellar approach on 66 patients ( group B ) . All knees were implanted with the same posterior-stabilized prosthesis by the same surgeon ( T.-S.T. ) with the same set of downsized instruments . Mean follow-up in both groups was 30.5 months ( range , 24 - 48 months ) . Patients in group A achieved an active straight-leg raise and 90 ° of flexion significantly earlier ( P=.017 and P=.025 , respectively ) . However , no significant difference was detected between the groups with respect to range of movement and Knee Society scores at all the postoperative visits and at final follow-up ( all , P>.05 ) . In contrast , the tourniquet time was significantly longer in group A ( P=.015 ) , with a higher incidence of medialized tibial component ( P=.031 ) . We believe that the early clinical results are similar between the mini-midvastus and mini-medial parapatellar approach . The mini-medial parapatellar approach is easier to initially apply and provides better visualization for TKA A prospect i ve , r and omized investigation compared early clinical outcomes of  total knee arthroplasty ( TKA ) using  conventional or minimally invasive surgical ( MIS ) approaches ( n = 44 ) . Outcome measures included isometric quadriceps and hamstrings strength , quadriceps activation , functional performance , knee pain , active knee range of motion , muscle mass , the Short Form-36 , and Western Ontario and McMaster University Osteoarthritis Index , assessed preoperatively and 4 and 12 weeks after TKA . Four weeks after TKA , the MIS group had greater hamstring strength ( P = .02 ) and quadriceps strength ( P = .07 ) , which did not translate to differences in other outcomes . At 12 weeks , there were no clinical ly meaningful differences between groups on any measure . Although MIS may lead to faster recovery of strength in patients undergoing TKA , there was no benefit on longer-term recovery of strength or functional performance In a prospect i ve single-centre longitudinal r and omized controlled trial 116 patients were allocated to the sub-vastus approach , and 115 to the medial parapatellar approach .  At one week follow-up , compared to baseline , range of motion , Knee Society ( KS ) global , KS knee , and KS pain scores were significantly better in the sub-vastus group . At the one year follow-up , WOMAC global and pain scores , SF36 physical function and role-physical scores , and EuroQol utility and pain score were significantly better in the sub-vastus group . The ease of exposure in the sub-vastus approach was significantly worse . There was no significant difference in length of stay or analgesia intake . The sub-vastus approach to total knee arthroplasty was more effective than a medial parapatellar approach at both one week and one year post-operatively , but surgeons reported a less easy exposure in the sub-vastus group Background Although total knee replacement ( TKR ) has been proven a very successful treatment modality for the end-stage knee osteoarthritis ( OA ) in obese patients , the rehabilitation period often is long and painful . Minimal invasive surgery ( MIS ) has gained much attention in TKR promising fast and less painful recovery . However , little is known about the effectiveness of the technique in the obese adult population . Methods One hundred consecutive patients with body mass index ( BMI ) > 30 kg/m2 and tricompartmental knee OA were r and omly assigned to undergo either st and ard TKR ( 50 patients ) or MIS-TKR ( 50 patients ) . The patients were assessed clinical ly and radiologically before the procedure and at subsequent postoperative follow-up visits , until 2 years after the operation . Results Knee society function and pain scores were significantly higher in MIS group for 3 months following surgery . Patients after MIS had also lower levels of pain during hospitalization . Tourniquet time was on average 7 min longer during MIS-TKR ( p = 0.03 ) but operative time was almost equal in both groups ( p = 0.11 ) . No statistical significant difference was found between groups regarding the amount of blood loss ( p = 0.49 ) or incidence of allogeneic blood transfusion ( p = 0.27 ) . Active straight leg raising was achieved 2.2 days earlier , on average , after MIS-TKR ( p < 0.001 ) . No severe complications or residual coronal and sagittal imbalance were identified . Component alignment was in normal limits and similar in both groups . In MIS group , higher BMI did not have a negative predictive effect on knee pain and function . Conclusions MIS is a reliable and safe option in obese patients undergoing TKR regardless the level of BMI . It is associated with improved early clinical outcome without sacrificing radiographic positioning of the implants Background Since the medial parapatellar ( MPP ) approach in conventional TKA can cause patellar maltracking and anterior knee pain , some orthopaedic surgeons use the midvastus ( MV ) approach instead of the MPP approach to reduce patellar maltracking . Minimally invasive surgical ( MIS ) TKA has been developed to limit the damage to the surrounding muscle and reduce the necessity of patellar eversion during surgery . Thus , MIS TKA might be associated with proper patellar tracking and a low incidence of anterior knee pain . However , this presumption has not been confirmed . Questions / purpose sWe asked whether the incidence of patellar maltracking and anterior knee pain differed with the MV and MPP in association with MIS TKA . Methods We prospect ively followed 59 patients ( 60 knees ) treated with 60 primary cemented MIS TKAs from August 2009 to September 2010 . We r and omized the patients into two groups : 30 who had a limited MPP approach and 30 who had a mini-MV approach . We recorded the occurrence of anterior knee pain , patellar tilting , and subluxation . The minimum followup was 12 months ( mean , 18.03 months ; range , 12.00–25.08 months ) . Results We found no differences in anterior knee pain ( two of 30 , 7 % versus two of 30 , 7 % ) , mean patellar tilt ( 3.4º ± 2.9º versus 3.0 ± 2.3º ) , and mean patellar subluxation ( 1.5 ± 1.1 mm versus 1.1 ± 0.7 mm ) between the limited MPP and mini-MV groups , respectively . Conclusions MIS TKA using either the MPP or MV approach has a low incidence of patellar maltracking and anterior knee pain . Level of Evidence Level I , therapeutic study . See the Guidelines for Authors for a complete description of the levels of evidence BACKGROUND Despite growing interest in minimally invasive surgery ( MIS ) techniques for total knee arthroplasty ( TKA ) , few r and omized controlled trials have compared MIS and conventional TKA using a combination of functional performance , knee pain , knee range of motion ( ROM ) , and surgical and radiographic outcomes . METHODS A prospect i ve , r and omized investigation comparing early outcomes of TKA using conventional or MIS approaches  ( n = 44 ) . Patients were assessed preoperatively , 48 hours , 4 and 12 weeks postoperatively by blinded evaluators . Outcome measures included timed-up- and -go , 100-ft walk , knee pain , passive knee ROM , Knee Society Score , blood loss , tourniquet time , hospital length of stay , surgical complications , and radiographic outcomes . RESULTS No significant differences in functional performance , knee pain , knee ROM , surgical , or radiographic outcomes were observed between groups at 48 hours , 4 or 12 weeks postoperatively . CONCLUSION While surgical and radiographic outcomes were not compromised with MIS surgery , there were also no improvements in pain , ROM , or functional performance with MIS TKA This prospect i ve r and omized study compared the clinical and radiological results of primary total knee arthropasty ( TKA ) using a mini-subvastus approach ( group I ; n = 35 ) or a st and ard approach ( group II ; n = 33 ) .  A posterior-stabilized prosthesis was used in both groups by the same surgeon . Mean follow-up was 18 months ( range 14 − 26 months ) . Patients in group I lost less blood and experienced less pain 1 day post-operatively . They achieved an active straight leg raise earlier and underwent less lateral retinacular releases . Functional outcome and the range of knee movements were significantly better in group I up to 9 months post-operatively , but there was no significant difference between the groups at 1 year post-operatively or at final follow-up . Reduced access and visibility in group I prolonged the operation time and result ed in five technical errors on radiographic evaluation . Based on these results , the authors currently only use the mini-subvastus approach for minimally invasive TKA in selected cases We performed a single-center , r and omized , double-blind study to compare muscle strength in patients who had undergone primary total knee arthroplasty ( TKA ) , performed using either a minimally invasive or a conventional surgical technique . We evaluated 30 knees in healthy age-matched subjects , 22 knees after conventional TKA ( conventional group ) , and 23 knees after minimally invasive surgery TKA ( MIS group ) .  The Hospital for Special Surgery ( HSS ) score , Oxford knee score ( OKS ) , and isokinetic ( 60º/s ) muscle strength were evaluated the day before surgery and 3 , 6 , and 12 months after surgery . HSS and OKS improved significantly over time during follow-up ( p<0.001 ) , but there was no significant difference between the groups ( p>0.05 ) . The extensor peak torque ( EPT ) and flexor peak torque ( FPT ) improved significantly over time ( p<0.001 ) and EPT was greater in the MIS group than in the conventional group during the follow-up period ( p<0.05 ) . There was no difference in FPT and the hamstring-to-quadriceps ratio between the groups . Although MIS patients had a significant deficit in extensor strength following TKA , compared with healthy controls , this approach offers a significant improvement in extensor muscle strength over conventional surgery . These results suggest that the MIS approach results in better outcomes with regard to maintaining extensor strength than the conventional surgical approach Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty ( TKA ) : the minimal-incision medial parapatellar ( MP ) approach and the quadriceps-sparing ( QS ) approach with side-cutting instruments . Sixty patients ( 80 knees ) with primary osteoarthritis were r and omly assigned to receive MP or QS TKA .  Postoperative alignment of the femoral component was significantly less valgus , and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach . One tibial outlier and 3 femoral outliers were observed with QS TKA . The overall postoperative hip-knee-ankle axis was more varus , and surgical time was longer with QS TKA .  Short-term isokinetic peak muscle torque , postoperative pain , and functional outcomes did not differ between the approaches Purpose The aim of the study was to identify whether less soft tissue and muscle damage during surgery will allow faster recovery after total knee arthroplasty in comparison with the conventional technique . A limited medial parapatellar approach without tibial medial collateral ligament ( MCL ) desinsertion was compared with the conventional parapatellar approach . Methods Three hundred patients were r and omized either into the minimally invasive group ( MIS group ) or into the conventional group ( CON group ) . The evaluation was based on the Knee Society Score , range of motion , blood loss , period of hospitalization and postoperative hemoglobin level . Results The MIS group showed faster recovery with immediate postoperative full weight-bearing and shorter length of stay ( 5 vs 10 days ) . Comparable Knee Society Scores ( 87.5 vs 88 ) , function scores ( 90 ) and alignment ( 5.5 ° vs 5.2 ° ) between the CON and MIS group were observed at a follow-up of 24 months . No increase in operative times ( 52 vs 51 min tourniquet time ) or no complications were observed . Reduced blood loss was observed in the MIS group ( 590 vs 989 ml ) . Conclusion The MCL sparing limited medial parapatellar approach allows good surgical exposure , easy extension proximally if necessary , contained closure after surgery with less bleeding , faster recovery , full weight-bearing without aid and most importantly no radiological malalignment . Level of evidence Therapeutic study , Level II Comparisons between mini-midvastus ( mMV ) and mini-medial parapatellar approach ( mMPP ) for total knee arthroplasty ( TKA ) have reported variable results . We compared two approaches with minimum two year follow up . Forty consecutive patients who underwent staged bilateral TKA were prospect ively r and omized for mMPP approach in one knee and mMV approach in the other . Clinical parameters ( muscle strength , pain , ROM , Knee Society Score ) and surgic.l parameters ( duration of surgery , blood loss , lateral releases ) were assessed at 2 , 6 , 12 weeks and 6 , 12 , 24 months postoperatively . Clinical outcomes revealed inconsistent pattern of differences at various intervals . Surgical outcomes were not different . There were no major differences in outcomes between the two approaches . We recommend someone use surgical approach with which they are most familiar BACKGROUND Studies on minimally invasive computer-assisted total knee arthroplasty ( MICA-TKA ) have shown promising results , but are limited by short follow-up . The purpose of this study was to compare the midterm radiographic features and functional outcomes between patients who underwent MICA-TKA and conventional TKA .  METHODS A total of 108 patients who were r and omized to undergo MICA-TKA or conventional TKA during 2004 and 2005 were contacted for a prospect i ve follow-up review . Patients who were lost to contact , have passed away , or declined to participate in the study were excluded . Objective functional measurements and radiographs were obtained for assessment . RESULTS By the time of this study , 2 patients from the conventional group had undergone revision TKA , one due to infection and one due to aseptic loosening . A total of 67 patients ( 62.04 % ) were followed up for an average period of 9.07 years ( 8.51 - 9.61 years ) . At follow-up , functional scores were comparable between the 2 groups . No significant intergroup differences were found in mechanical knee alignment and component placement angle in the coronal views . No statistical or clinical significance were noticed in radiographic signs of component loosening . CONCLUSIONS MICA-TKA provided similar clinical , functional , and radiographic outcomes compared with conventional TKA after an average of 9-year follow-up . This technique can be used to exploit its short-term advantages without compromising midterm outcomes BACKGROUND / PURPOSE Quadriceps-sparing minimally invasive total knee arthroplasty ( TKA ) has been proposed to limit surgical dissection without compromising surgical outcome . We conducted a prospect i ve and r and omized study to compare the outcomes of patients who underwent quadriceps-sparing TKA  with the outcomes of those who underwent st and ard medial parapatellar TKA  , after a 2-year follow-up period . METHODS Eighty primary TKA procedures that were to be performed in 60 osteoarthritis patients were r and omly assigned to either a  quadriceps-sparing ( 40 knees ) or a  st and ard medial parapatellar ( 40 knees ) group . All surgeries were design ed to set the prosthesis with a femoral component alignment of 7 ° valgus and a tibial component alignment that was perpendicular to the tibial shaft . Surgical time and  tourniquet time were recorded . Outcome variables included knee function , as defined by a hospital for special surgery knee score ; quadriceps muscle strength , which was measured by an isokinetic dynamometer ; pain , as indicated on a visual analog scale ; prosthetic position , which was measured on plain radiograph ; and range of motion . RESULTS Patients who underwent the 38 quadriceps-sparing and 37 st and ard TKA  procedures completed the 2-year follow-up period without any infection or revision . The mean surgical time and tourniquet time were significantly longer in the quadriceps-sparing group . The mean peak quadriceps muscle strength , hamstring muscle strength , normalized muscle balance ( hamstring/quadriceps ratio ) , pain score , function score , and range of motion were comparable in both groups at 2 months and 2 years . In the quadriceps-sparing group , both the femoral and the tibial components were significantly more varus-deviated from the expected position . CONCLUSIONS Patients undergoing quadriceps-sparing and st and ard medial parapatellar TKA  had comparable outcomes for quadriceps muscle strength , hamstring-quadriceps balance , and knee function ; however , the quadriceps-sparing TKA was more time consuming surgically and result ed in a less accurate prosthesis position The mini-midvastus ( MV ) approach to total knee arthroplasty ( TKA ) minimizes damage to the extensor mechanism ; however , the mini-subvastus ( SV ) approach is design ed to avoid such damage . Quadriceps weakness following TKA can have a significant impact on the activities of daily living , particularly st and -to-sit down ( STSD ) and sit-to-st and up ( STSU ) activities . Fifty-three subjects diagnosed with primary osteoarthritis and scheduled to undergo TKA were r and omized to receive an MV or SV surgical approach and were given identical postoperative orders . Compared with age-matched controls , the SV group had a quicker return of normal peak knee extension moment during STSU , whereas the MV group had a quicker return of normal movement patterns in hip , knee , and ankle parameters during STSD yet represented the higher functioning subjects as more MV subjects had difficulty completing the task as instructed . Considering both movements are required for daily living , neither surgical group was found to have a significant advantage over the other in functional outcome through 6 months post-TKA Background Less invasive dissection of the extensor apparatus , one of the aspects of minimally invasive surgical ( MIS ) TKA , might result in less reduction of postoperative quadriceps strength . However , it is unclear whether MIS is associated with less strength reduction . Questions / purpose sWe asked whether knee strength ( extensor or flexor torque ) would be greater in patients having a MIS TKA  compared with patients having a st and ard TKA  and whether knee scores , alignment , ROM , tourniquet and operating times , and hospital length of stay were improved . Methods We prospect ively recruited 52 patients awaiting MIS or st and ard TKA , matched for age , weight , height , BMI , sex , and surgically treated side , but not r and omized .  Isokinetic tests  were performed preoperatively and postoperatively to obtain peak values of extensor and flexor torque . Postoperative-to-preoperative ratios and the extensor-flexor torque ratio also were calculated . Results Mean baseline extensor torques were 57 Nm and 53 Nm for MIS and st and ard TKAs , respectively . At 8 weeks postoperatively , absolute values of the mean postoperative knee extensor torque also were similar : 47 and 45 Nm for patients with MIS and st and ard TKAs , respectively . The postoperative-to-preoperative ratios were 0.8 for extensor and flexor torque in both groups . The extensor-flexor torque ratios were similar between groups . Conclusions Our data suggest a less invasive dissection of the extensor apparatus involved in MIS TKA does not enhance postoperative quadriceps strength . Level of Evidence Level III , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence
target: The MSV approach ranked better concerning clinical scores ( the lowest visual analogic scale , the higher KSS and KSFS ) and functional outcomes ( the shortest straight leg raise , the greatest degree of flexion and range of motion ) .
  Concerning perioperative data , the MSV evidence d the shortest hospital stay , while the MPP the shortest surgical duration and lowest estimated blood loss .
  According to the main findings of the present study , the mini-subvastus approach for total knee arthroplasty demonstrated superior overall compared to the other approaches .
background: Alternatives to the classical medial parapatellar ( MPP ) approach for total knee arthroplasty ( TKA ) include the mini-medial parapatellar ( MMPP ) , mini-subvastus ( MSV ) , mini-midvastus ( MMV ) and quadriceps-sparing ( QS ) approaches .
  The best approach has been not fully clarified .
  The purpose of the present study was to conduct a Bayesian network meta- analysis comparing these approaches .