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A Prospective Randomized Study of Minimally Invasive Total Knee Arthroplasty Compared with Conventional Surgery
N. Wülker, PhD, MD1; J.P. Lambermont, MD2; L. Sacchetti, MD3; J.G. Lazaró, MD4; J. Nardi, MD5
1 Orthopaedic Department, Tübingen University Hospital, Hoppe-Seyler-Strasse 1-3, 72076 Tübingen, Germany. E-mail address: wuelker@med.uni-tuebingen.de
2 CHU André Vésale University Hospital, Rue Gozeé 706, 6110 Montigny-le-Tilleul, Belgium
3 General Hospital, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy
4 Hospital Universitario de Fuenlabrada, Camino del Molino s/n, 28940 Fuenlabrada, Madrid, Spain
5 University Hospital Vall d'Hebron, Paseo del Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Smith and Nephew. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A commentary by Joshua David Nelson, MD, PharmD, is available at www.jbjs.org/commentary and as supplemental material to the online version of this article.
Investigation performed at the Orthopaedic Department, Tübingen University Hospital, Tübingen, Germany; University Hospital CHU André Vesalé, Montigny-le-Tilleul, Belgium; General Hospital, Policlinico di Modena, Modena, Italy; Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain; and University Hospital Vall d'Hebron, Barcelona, Spain

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jul 07;92(7):1584-1590. doi: 10.2106/JBJS.H.01070
A commentary by Joshua Nelson, MD, PharmD, is available here
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Despite intense debate regarding whether minimally invasive techniques for total knee arthroplasty improve clinical outcomes over standard techniques, few prospective randomized trials addressing this debate are available in the literature. We therefore designed this multicenter study to assess the overall safety and effectiveness of a minimally invasive approach without the use of computer navigation in comparison with conventional knee arthroplasty.


We prospectively randomized 134 patients (101 women and thirty-three men, with an average age of 70.1 years) to undergo surgery for total knee arthroplasty with use of either minimally invasive knee instruments (sixty-six patients) or a standard approach (sixty-eight patients). The follow-up period was one year.


On the basis of our sample size, no significant difference was detected between the groups in any of the relevant clinical areas assessed: total range of motion, Knee Society total and function scores, and visual analog scores for pain and activities of daily living. Patients who underwent minimally invasive surgery had a longer mean surgical time (by 5.6 minutes) and had less mean blood loss (by 17 mL). Radiographic measurements demonstrated reliable implant positioning in both groups. Seven patients in each group had an adverse event related to their procedure.


On the basis of the numbers, no significant advantage to minimally invasive total knee arthroplasty over a conventional technique was observed. Greater sample sizes and a longer follow-up period are required to fully determine the long-term safety and efficacy of this minimally invasive surgical technique.

Level of Evidence: 

Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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