The John Insall Award: No Benefit of Minimally Invasive TKA on Gait and Strength Outcomes: A Randomized Controlled Trial

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/Purposes We hypothesized TKA performed through a mini-subvastus approach would improve subjective and objective and subjective function compared to a standard medial parapatellar approach 2 months after surgery.

Methods We randomized 40 patients into two groups using either the mini-subvastus approach or standard medial parapatellar approach. Patients were evaluated preoperatively and 2 months after surgery. We assessed subjective functional outcome and quality of life (QOL) using routine questionnaires (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.