Lateral Versus Medial Approach In Valgus Total Knee Arthroplasty:a Systematic Review And Meta-analysis

Objective: At present,it is still controversial which is better in total valgus knee arthroplasty by medial approach or lateral approach.In this paper,a meta-analysis is applied to compare the clinical effect of the lateral and medial approach of valgus knee replacement Methods: Comparative studies concerning medial and lateral approaches in valgus knee arthroplasty published from January 1,2000 to April 1,2018 were searched from English databases such as PubMed,EMBASE,Web of Science and Chinese databases such as(CNKI),WanFang and(VIP).Seven deviation risk measurement tools in the non-random intervention study(ROBINS-I)were used to evaluate the literature quality and select the high-quality research.The measurement outcomes including operation time,postoperative knee joint scores,range of motion of the knee joint,knee valgus angle,postoperative residual knee valgus rate and incidence of complications were analyzed statistically and forest plots were obtained.Results: Eight eligible retrospective cohort studies were selected.The average operation time of lateral approach was longer than that of medial approach [MD=2.72;95%CI(0.03,5.41),P=0.05].For valgus total knee arthroplasty,the lateral approach had lower postoperative residual knee valgus rate than that of medial approach [OR=0.13;95%CI(0.05,0.36),P < 0.000 1] and better American Knee Society scores [SMD=0.17;95%CI(0.03,0.32),P=0.02].There was no significant difference in the postoperative knee valgus angle TFM[WMD=-0.05,95%CI(-0.23,0.13),P=0.58] or TFA[MD=0.15,95%CI(-0.09,0.38),P=0.22],incidence of complications[OR=0.71,95%CI(0.40,1.26),P=0.24] and range of motion of the knee joint [MD=4.62,95%CI(-4.22,13.46),P=0.31] between two methods.Conclusion: In order to improve the function of knee joint and improve the correction rate of valgus deformity,lateral approach is superior to medial approach in total valgus knee arthroplasty.