title: Minimal invasive and computer-assisted total knee replacement compared with the minimal invasive technique: a prospective, randomized trial with short-term outcomes Comparison of two minimally invasive implantation instrument-sets for total knee arthroplasty Midterm outcomes of electromagnetic computer-assisted navigation in minimally invasive total knee arthroplasty Comparative study between computer assisted-navigation and conventional technique in minimally invasive surgery total knee arthroplasty, prospective control study. Mini-incision versus mini-incision and computer-assisted surgery in total knee replacement: a radiological prospective randomised study. Blood loss after minimally invasive total knee arthroplasty: effects of imageless navigation. Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study.
abstract: Abstract Introduction Up to now , no prospect i ve , r and omized comparisons between minimal invasive and computer-assisted total knee arthroplasty ( MICA-TKA ) , and minimal invasive technique ( MI-TKA ) has been documented to evaluate not only clinical , but also radiologic results of the MICA-TKA . This prospect i ve , r and omized study was performed to compare the short-term results of MICA-TKA with minimal invasive technique MI-TKA for 6-month follow-up . Patients and methods We reported the clinical and radiological results of 80 subjects who had cruciate-substituting , TKA-implanted primary total knee arthroplasties using either minimal invasive and computer-assisted technique ( 40 patients Group I ) or minimal invasive technique ( 40 patients , Group II ) .  Tourniquet time , length of skin incision , and total blood loss were compared . Knee society scores ( KSSs ) , knee society functional scores ( KSFSs ) , range of motion ( ROM ) , and radiographic results were assessed and reported preoperatively and at 6-month follow-up . Results The accuracy of the implantations in relation to the coronal mechanical axis in Group I was superior to that of Group II ( P < 0.05 ) . The femoral rotational profile revealed the prosthesis in Group I that was implanted with significantly less internal rotation than in Group II . The average blood loss in patients of Group I was significantly reduced as compared to patients of Group II . No significant difference was detected in terms of tourniquet time or length of skin incision . Clinical results , with regard to ROMs and KSSs , as well as KSFSs were equally good in both the groups . Conclusions Better alignment and similarity of good clinical results at short-term follow-up may provide subjects who receive MICA-TKA with long-term endurance of their implants . Further studies on longer-term outcomes and functional improvements are required to vali date these possibilities Several choices of instrument systems are available for minimally invasive surgical approaches . There are reports that one alternative , the quadriceps sparing , side-cutting instrumentation , results in diminished implantation accuracy . A total of 108 patients were r and omized to undergo TKA either using side-cutting implant instrumentation ( Group A ) or anterior – posterior mini-incision instrumentation ( Group B ) . All TKAs were operated on with a minimal invasive , mini-midvastus surgical approach . 50 % of the TKAs were performed with computer-assistance in each cohort . The radiographic parameters , clinical outcomes and knee scores were evaluated preoperatively and 3 months postoperative . In Group B , we found significantly higher accuracy for the mechanical axis of the limb ( range ±3 ° : Group A 54 % versus Group B 89 % , p = < 0.001 ) , medial proximal tibial angle ( range ±3 ° : Group A 85 % versus Group B 98 % , p = < 0.027 ) and tibial slope ( range ±3 ° : Group A 59 % versus Group B 85 % , p = < 0.007 ) . The application of the navigation system could only significantly reduce outliers ( accuracy > 3 ° ) in Group B. Clinical outcomes and knee scores were similar in both groups and were not influenced by computer-assistance . Using the anterior – posterior , mini-incision instruments for minimally invasive TKA will lead to higher implantation accuracy when compared to the quadriceps sparing side-cutting instrumentation . The navigation technique could not compensate for shortcomings of the side-cutting instrumentation . The clinical relevance of this study is that the quadriceps sparing side-cutting instrumentation should not be used for TKA because of unacceptable reduced implantation accuracy Background A combination of two emerging technologies , computer-assisted navigation and minimally invasive surgery , in total knee arthroplasty has gained increasing interests from orthopedic surgeons around the world . To date , there has never been any midterm study for clinical and radiographic outcomes from using an electromagnetic computer-assisted navigation system . In this study , we aim ed to systematic ally compare clinical and radiographic outcomes of minimally invasive surgery in total knee arthroplasty ( MIS-TKA ) performed with and without electromagnetic computer-assisted navigation at immediate and midterm follow-ups . Methods A total of 151 patients ( 160 knees ) who underwent MIS-TKA were r and omized to be operated with electromagnetic computer-assisted navigation ( group I : 75 patients , 80 knees ) or without the navigation ( group II : 76 patients , 80 knees ) . The clinical and radiographic outcomes of immediate , 6-week postoperative follow-up and average 6.1-year follow-up were compared . Results On immediate , 6-week postoperative follow-up , clinical and radiographic outcomes did not reveal any difference between the two groups except for the fact that the operative time was longer in the navigation group . On 6.1-year follow-up , a total of 58 patients ( 63 knees ) from group I and 58 patients ( 61 knees ) from group II were reevaluated . There were no significant differences in clinical and radiographic loosening and in complications between the two groups . Conclusion In this study , no significant differences of clinical and radiographic outcomes were found for immediate and midterm follow-ups of MIS-TKA performed with and without electromagnetic computer-assisted navigation except for the additional operating time in the navigation group BACKGROUND Both Minimally Invasive surgery ( MIS ) and Computer-Assisted Surgery ( CAS ) are useful in Total Knee Arthroplasty ( TKA ) . Minimally invasive total knee arthroplasty was associated with decreased blood loss , shorter hospital stays , and increased range of motion .  Computer-assisted surgery in total knee arthroplasty was developed to improve the positioning of implants during surgery . OBJECTIVE To evaluate radiographic results relative to component position and limb alignment when using a navigation system compared with conventional technique in MIS-TKA . MATERIAL AND METHOD A prospect i ve control study was performed in 180 patients who underwent total knee arthroplasty by one surgeon . All patients were r and omly divided into two groups , Conventional and Navigation TKA .  Intra- , post-operative data , and postoperative limb alignment were recorded for comparison in both groups . RESULTS The postoperative mechanical axis was within 3 degrees of neutral mechanical alignment in 94 % of the navigation group and 87 % in conventional group ( p = 0.13 ) . Registration time of navigation group is 13.58 minutes . No statistical significant difference was found in tourniquet time and postoperative blood loss in both groups . CONCLUSION The use of navigation in total knee arthroplasty increases accuracy in limb and implants alignment , and does not increase complications and surgical times The aim of this trial was to compare the radiological results of 74 patients undergoing a mini-invasive total knee replacement ( TKR ) using either a traditional alignment guide ( MIS group ) or a computer assisted alignment system ( MICA group ) . All the patients were prospect ively r and omised to either group and the same implant was used for both groups . At 8 months post-operatively , the frontal femoral component angle ( FFC ) , the frontal tibial component angle ( FTC ) , the hip-knee-ankle angle ( HKA ) and the sagittal orientation of components ( slopes ) were evaluated respectively . The slopes of the femoral component and the FTC angle were statistically better aligned in the MICA group ( p<0.001 ) . The MICA group showed both a significant fewer number of outliners and a significant higher number of implants with all five radiological parameters ideally aligned . The operative time was statistically longer in the computer assisted group A prospect i ve cohort study of 100 patients undergoing primary minimally invasive total knee arthroplasty was carried out to determine blood loss after this procedure and to examine the efficacy of navigation on blood saving . The patients were divided into two groups according to the surgical technique , and underwent either computer-assisted navigation or manual procedures . All operations were performed by a single surgeon using an identical approach . To minimize blood loss , an intraoperative tourniquet was used , but no postoperative drainage was applied . Although the mean surgical time was longer in the navigated group than in the manual group ( 119.2 vs. 90.9 min ; p < 0.001 ) , the reductions in hemoglobin level ( 1.40 vs. 1.38 g/dL ; p = 0.642 ) and calculated blood loss ( 470.77 vs. 482.73 mL ; p = 0.796 ) were similar in both groups . Four patients in both groups required blood transfusion . With minimally invasive techniques and drainage avoidance , our study suggests that the blood loss after minimally invasive total knee arthroplasty was not significantly affected by the use of imageless navigation BACKGROUND There is little information on the feasibility of computer navigation when using a minimally invasive approach for total knee arthroplasty , during which the anatomic l and marks for registration may be obscured . The purpose of the present study was to determine the radiographic accuracy of this technique and to compare the rate of functional recovery between patients who underwent computer-assisted minimally invasive arthroplasty and those who underwent conventional total knee arthroplasty .  METHODS One hundred and eight consecutive patients were r and omized to undergo computer-assisted minimally invasive total knee arthroplasty or conventional total knee arthroplasty .  Perioperative pain management was st and ardized . The clinical parameters , long-leg radiographs , and functional assessment scores were evaluated for six months postoperatively . RESULTS Patients who underwent computer-assisted minimally invasive total knee arthroplasty had a significantly longer operative time ( by a mean of twenty-four minutes ) and a significantly shorter inpatient stay ( 3.3 compared with 4.5 days ) in comparison with those who underwent conventional arthroplasty ( p < /= 0.001 ) . Significantly more patients in the computer-assisted minimally invasive total knee arthroplasty group were able to walk independently for more than thirty minutes at one month ( p = 0.04 ) . The percentage of patients with a coronal tibiofemoral angle within + /-3 degrees of the ideal was 92 % for the computer-assisted minimally invasive total knee arthroplasty group , compared with 68 % for the conventional total knee arthroplasty group ( p = 0.003 ) . CONCLUSIONS Although specific clinical parameters reflect an early increased rate of functional recovery in association with computer-assisted minimally invasive total knee arthroplasty within the first postoperative month , the main advantage of this technique over conventional total knee arthroplasty is improved postoperative radiographic alignment without increased short-term complications
target: There was no significant difference in the outliers on complications , knee flexion , and postoperative functional scores .
  Coronal plane tibial component showed statistically significant number of outliers in the MIS group demonstrating superior component positioning in the MIS CA group .
  Computer-assisted minimally invasive TKA is superior than the st and ard MIS TKA in terms of component positioning ; however , it is unclear if this will have any long-term clinical implication s. The increased operative time , although clinical ly relevant , does not appear to be associated with an increase in complications
background: BACKGROUND Median parapatellar approach is the most used for total knee arthroplasty ( TKA ) .
  With the advent of enhanced recovery and shorter length of hospital stay , there is an increasing pressure on surgeons to perform surgery through smaller incisions .
  Minimally invasive ( MIS ) TKA allows earlier functional recovery ; it is not clear if this is associated with more complications .
  It is also unclear if computer-assisted minimally invasive ( MIS CA ) TKA has any affect on improving patient outcomes .
  We performed a systematic review and meta- analysis comparing MIS CA vs MIS TKA .