Increased surgery time and blood loss volume related with minimally invasive midvastus TKA .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(13):2 BMC Musculoskelet Disord. 2016 Jan 13;17(1):19.69 patients scheduled for total knee arthroplasty were randomized to have the surgery performed with either a minimally invasive midvastus (MIS) approach, or a conventional medial parapatellar approach, with the assistance of computer navigation. The purpose of this study was to compare pain, range of motion (ROM), duration of surgery, intra-/post-operative blood loss, and other clinical outcomes between the two approaches over a total of 6-month follow-up. Results demonstrated that the MIS technique was associated with significantly higher pain at postoperative week 2, longer duration of surgery, and blood lost during the first 24 postoperative hours. All other outcome scores were comparable between study groups.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
To avoid certain disadvantages that are associated with the conventional medial parapatellar approach in total knee arthroplasty, minimally invasive techniques (MIS) have been suggested to minimize local tissue disruption, neurovascular tissue, and potential dislocation of the patella. These complications of surgical trauma may manifest negatively in clinical outcome and increase length of hospitalization. However, the current body of evidence investigating the benefits of computer- assisted MIS TKA are inconclusive due to conflicting reports of efficacy, thus warranting the present study.
¿Cuál era la pregunta principal de la investigación?
In patients scheduled for total knee arthroplasty, did a computer-assisted, minimally invasive midvastus technique result in significant advantages when compared to standard medial parapatellar approach, with respect pain, range of motion, duration of surgery, blood-loss, and other clinical outcomes over 6-month follow-up?
- Pain scores between study groups were significantly different (p=0.003); post-hoc comparison of between groups differences revealed a 1.20 point difference in favor of patients in the conventional group (p=0.01) at postoperative week two. At all other follow-up points, there were no significant between-group differences recorded.
- Range of motion (ROM) measurements were comparable between study groups, as there were no significant differences recorded at any follow-up point (p=0.12).
- Surgery time was observed to be significantly longer for patients in the MIS group when compared to the conventional group (approximately 30.97 minutes longer, p<0.001). Although intra-operative blood loss measurements were comparable between study groups, first 24-hour blood loss was significantly higher for patients in the MIS group (approximately 315.02 mL more, p=0.002).
- Measurements recorded for the chair-rise test, quadriceps strength, and anterior knee pain (scored with either a “yes” or “no”) were comparable between study groups at all follow-up points.
- WOMAC and KSS scores were additionally comparable between study groups at all follow-up points.
¿Qué es lo que más debo recordar?
When comparing a minimally invasive midvastus (MIS) technique to the conventional medial parapatellar approach for total knee arthroplasty, the MIS technique was associated with significantly higher pain scores at postoperative week 2, in addition to significantly increased surgery duration and first 24-hour blood loss.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this study demonstrate that a computer-assisted minimally invasive midvastus (MIS) technique for total knee arthroplasty had no significant advantages when compared to conventional technique. Future randomized controlled trials with larger patient populations should be conducted in order to replicate and substantiate these findings.
DESCARGO DE RESPONSABILIDAD
El contenido de esta página tiene únicamente fines informativos y no pretende sustituir el consejo, diagnóstico o tratamiento médico profesional. Si necesita tratamiento médico, busque siempre el consejo de su médico o acuda al servicio de urgencias más cercano. Las opiniones, creencias y puntos de vista expresados por las personas sobre el contenido que se encuentra en esta página no reflejan las opiniones, creencias y puntos de vista de OrthoEvidence.
0 de 4 artículos mensuales GRATIS desbloqueados
