Comparison of minimally invasive approaches and standard median parapatellar approach for total knee arthroplasty: A systematic review and network meta-analysis of randomized controlled trials

BACKGROUND: 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 effectiveness four minimally surgery (MIS) approaches and medial parapatellar (MPP) approach improve American Knee Society Score (KSS) in primary TKA. MATERIALS AND METHODS: Studies were searched on PubMed, Embase, Cochrane Library (CENTRAL), Web Science Direct up June 2018 with a major focus outcome KSS. Risk bias assessed using risk tool. Quality assessment performed GRADE system. Both pair-wise meta-analyses are calculated MIS TKA approaches. RESULTS: Eleven trials 1025 knees undergoing included. Our analysis showed that both MPP provided improvement terms short-term (four-eight weeks) total, objective functional network-meta revealed trend towards superior KSS over standard However, statistical advantages only observed mini-MPP group for compared conventional quadriceps-sparing (QS) groups. CONCLUSIONS: Evidence shows effective alternatives surgeons should be cautiously optimistic about improvement.