Mini-Midvastus Approach Shows Improved Short- Term Outcomes in Primary TKA Compared to Medial Parapatellar Approach

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1 Mini-Midvastus Approach Shows Improved Short- Term Outcomes in Primary TKA Compared to Medial Parapatellar Approach D Y L A N Y O U N G, B. S. S A R A H S H I, M. S. K A T E M A T T H E W S, M. A. K I P L I N G S H A R P E, M. D. 1

2 Disclosure Statements Dylan Young, B.S. No financial conflicts to disclose Sarah Shi, M.S. Employee of Stryker Orthopedics Kate Matthews, M.A. Paid writing consultant with OrthoWriting Kipling Sharpe, M.D. Received research funding from Stryker 2

3 Background Total knee arthroplasty (TKA) had traditionally been performed using a standard medial parapatellar approach (MPP) This involves incising the quadriceps tendon Since the early 2000 s, alternate minimally invasive surgical options have been introduced. The most common is the mini-midvastus approach (MMV) This involves incising the vastus medialis obliquus muscle and avoids the quadriceps tendon altogether 3

4 The Hypothesis Primary TKA performed through the MMV approach will provide better subjective and objective outcomes when compared to the MPP approach up to one-year postoperatively 4

5 Patient Selection and Methods One TKA design used (Triatholon, Stryker, Mahwah, NJ) Non-randomized: each surgeon chose their preferred surgical approach and did not mix surgical approaches A total of 381 patients and 446 knees were divided into 2 cohorts MMV cohort (182 patients/221 knees) MPP cohort (199 patients/225 knees) Progress assessed with two scoring measures The 2011 Knee Society Score (KSS) The Oxford Knee Score (OKS) 5

6 The 2011 Knee Society Score Three subjective (patient-reported) components Patient Satisfaction (KSS-S), Patient Expectation (KSS-E), and Functional Knee Score (KSS-F) One objective (surgeon-reported) component Objective Knee Score (KSS-O) Scores collected pre-operatively, at six weeks, six months, and one year 6

7 The 2011 Knee Society Score * denotes significance when comparing values between the two cohorts (p<0.05). ^ denotes significance when comparing change from preoperative to the specified time point between the two cohorts (p<0.05). 7

8 The Oxford Knee Score * denotes significance when comparing values between the two cohorts (p<0.05). ^ denotes significance when comparing change from preoperative to the specified time point between the two cohorts (p<0.05). 8

9 Results At 6 weeks, the MMV cohort had significantly higher KSS-F and KSS-O scores No significant difference in KSS-S, KSS-E, and OKS scores At 6 months, the MMV cohort had significantly higher KSS-S, KSS-F, KSS-E, and KSS-O scores At 1 year, the MMV cohort had significantly higher KSS-F and KSS-O scores No significant difference in KSS-S, KSS-E, and OKS scores 9

10 Discussion KSS-F and KSS-O demonstrated significantly higher scores in the MMV cohort at all time points This includes one patient-reported component (KSS-F) and one surgeon-reported component (KSS-O) Although OKS did not demonstrate any significant difference between groups, it is possible that using three patient-reported components with KSS allowed for more specificity with subjective assessment 10

11 Discussion The significantly higher KSS-O scores in the MMV group supported the hypothesis Patients achieved better objective motion and function at 6 weeks, 6 months, and 1 year postoperatively The results suggest that avoiding incision of the quadriceps tendon through a MMV approach allows for better objective and subjective recovery up to one year postoperatively 11

12 References Huang A-B, Wang H-J, Yu J-K, Yang B, Ma D, Zhang J-Y. Are There Any Clinical and Radiographic Differences Between Quadriceps-sparing and Mini-medial Parapatellar Approaches in Total Knee Arthroplasty After a Minimum 5 Years of Follow-up? Chin Med J. 2015;128(14): Pongcharoen B, Yakampor T, Charoencholvanish K. Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA. Clin Orthop. 2013;471(5): Bonutti PM, Zywiel MG, Seyler TM, et al. Minimally invasive total knee arthroplasty using the contralateral knee as a control group: a case-control study. Int Orthop. 2010;34(4):