Midvastus Versus Medial Parapatellar Approaches In Total Knee Arthroplasty: A Systematic Review

Objective: To evaluate the efficacy and safety of the midvastus versus medial parapatellar approaches approach in total knee arthroplasty.Methods: A computerized search of articles published between 1980 and April 2010 was performed using The Cochrane Library,MEDLINE,EMBASE and Chinese Biomedicine Database(CBM) to identify the clinical controlled trials comparing midvastus approach versus medial parapatellar approaches in total knee arthroplasty. The quality of included studies was critically assessed and data analyses were performed with STATA9.0.Results: 15 studies in 16 articals were included, involving 6 randomized trials,4 quasi-randomized trials and 5 non- randomized trials. Meta-analyses showed that compared with medial parapatellar approach,midvastus approach got lower rate of lateral retinacular release[RR= 0.337,95%CI(0.211,0.540),P=0.000] and complications postoperation[RR= 0.600,95%C(I0.366,0.981),P= 0.042](knee joint stiffness:[RR= 0.375,95%CI(0.181,0.773),P= 0.008]).There was no statistical difference on functional scores,range of motion(1M: [WMD=2.134,95%CI(-0.531,4.799),P=0.116],6W: [WMD=1.747,95%CI(-0.706,4.200),P=0.163],3M: [WMD=-0.985,95%CI(-4.606,2.637),P=0.594]),operation time[WMD=2.048,95%CI(-1.485,5.580),P=0.256],tibio-femoral angle[WMD=0.047,95%C(I-0.299,0.393),P=0.789],patellar tilting[WMD=1.024,95%CI(0.083,1.966),P=0.033] in the two groups. And the time of straight leg raise postoperation and pain scores in the midvastus approach was no more than But the patella translation was much more than medial parapatellar approach.Conclusions: Based on these evidences, the midvastus approach for total knee arthroplasty is much safer than medial parapatellar approach for the total knee arthroplasty in nonobese patients with less than 15 degrees joint deformity, but due to the poor quality of the included trials, much more high quality randomized trials are needed.