The Clinical Research Of Quadriceps-sparing Approach In Primary Total Knee Arthoplasty

Background:In 1974,the world's orthopedic community reported the first case of total knee replacement,since then,total knee arthroplasty as an advanced,effective treatment of knee osteoarthritis has been rapid development.After 30 years of rapid development,the medial patella lateral approach as the main operating approach has been widely used.Because the medial patellar approach can provide a good surgical field of vision and adequate operating space.However,the patellar medial approach can provide a good surgical exposure at the cause of its destruction of the quadriceps and related ligaments at the same time the patella open.Therefore,in the early time of 21st century,artificial knee joint minimally invasive surgery(MIS)has been invented by joint surgeon.A large number of studies have shown that the quadriceps retention method of artificial total knee arthroplasty can provide faster postoperative rehabilitation,less surgical bleeding,greater knee activity and less perioperative pain than the traditional medial patellar approach.However,there are still some studies that suggest the minimally invasive total knee arthroplasty with the quadriceps sparing pathway can lead to a large number of complications.Therefore,to choose the quadriceps sparing approach of minimally invasive total knee replacement surgery or not has been remain to be solved.However,more research are needed to find out the result.Purposes:In the present research,all research about the application of quadriceps sparing approch in the development of total knee arthroplasty was reviewed.All of the randomized clinical trials(RCTs)which declared to apply the quadriceps sparing approach to total knee replacement were applied to the present meta-analysis and systematic review to compare the clinical outcome of the quadriceps sparing approach and the traditional medial patella lateral approach in the short and long term follow-up.Thus,we conduct the meta-analysis to guide the clinical joint surgeon to choose a more appropriate approach to complete the total knee arthroplasty.Methods:In the present research,PubMed,Embase,Cochrane Library,and Web of Science databases were searched for all relevant studies from 1990 to August 2016 through the network.The search terms include:"total knee replacement","total knee arthroplasty","quadriceps muscle-sparing".All the relevant randomized controlled studies were included in the meta-analysis.All the data were analyzed using RevMan 5.3 software,and the continuous variables were analyzed by comparing the weighted mean WMD)and 95%confidence interval(CI).The two classifiers were reported by the risk(OR)and 95%confidence interval(CI),and heterogeneity was performed by the 12 test.Result:In the present study,a total of 7 RCTs,including a total of 520 knee joint,according to the pooling effect of the results found in the research,postoperative pain VAS score,straight leg elevation and postoperative KS S score between the quadriceps sparing approach and the traditional medial patella lateral approach have shown no significant difference.There were no significant differences between the two groups in the other variable.At the same time,quadriceps retention path is prone to more extreme cases or failure cases.Conclusion:According to its principles and characteristics,the quadriceps sparing approach may have the following deficiencies:(1)Surgical visual field exposure is too small to provide adequate operating space.Therefore the operation process is relatively complex so that the difficulty of the operation become lager.(2)with the difficulty raising,complications associated with the operation time has come out.Not only the use of tourniquet time,but also infection,lower extremity swelling,deep vein thrombosis and other complications has become more and more regular.Therefore,we believe that the quadriceps sparing approach should be recommended to senior doctors with a rich experience of the primary knee replacement surgery to use.