Minimally invasive versus conventional approaches in total knee replacement/arthroplasty: A review of the literature

Background: Life expectancy lengthening and aging of population resulted in dramatically increase of patients with osteoarthritis. Total knee arthroplasty is widely used as the gold standard in order to relieve pain, correct deformity and restore function. A contemporary and controversial topic, is that of minimally invasive surgery for TKA. The minimally invasive approaches are based on the concept that they don't violate the extensor mechanism, resulting in earlier functional recovery, shorter hospital stay and enhanced patients' overall satisfaction. The most commonly used MIS approaches in TKA are the subvastus, midvastus and the quadriceps sparing. There is a debate regarding the efficacy and safety of these methods. Objective: In this article we will review the current literature (randomized controlled trials and systematic reviews/meta-analyses) on MIS compared to traditional approach and analyse their clinical safety, efficacy and long-term results. Design: Comparison of well-designed studies have tried to demonstrate the advantages/disadvantages, the clinical results and the complications of the MIS approaches compared to the MPP approach. Results: MIS approaches seem to provide advantages in the immediate post-operative period accompanied by increased reports of complications. Consequently, further investigation based on large well-designed studies with long-term results are warranted to further clarify MIS effectiveness/safety.