Is the Mini-Midvastus Approach for Total Knee Arthroplasty Any Better in Reducing Blood Loss and Hospital Stay?

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Abstract
Total knee arthroplasty (TKA) is a widely used surgical intervention for advanced osteoarthritis, with evolving surgical techniques aiming to reduce blood loss and hospital stay. The minimally invasive midvastus (MMV) approach is hypothesized to minimize soft tissue damage and promote faster recovery compared to the classic medial parapatellar (MPP) approach. This study aimed to compare clinical and radiological outcomes, including perioperative blood loss and hospital discharge timing, between the MMV and MPP approaches. A total of 99 patients with advanced osteoarthritis who underwent primary TKA between 2013 and 2019 were prospectively analyzed. Patients were divided into MMV (n = 50) and MPP (n = 49) groups. All surgeries were performed by the same experienced surgeon using the same prosthetic system and perioperative protocols. Clinical outcomes included hemoglobin (Hb), hematocrit (Hct), discharge timing, range of motion (ROM), Visual Analog Scale (VAS), and Oxford Knee Score (OKS). Radiological outcomes included alignment and component positioning. Statistical analysis was conducted with significance set at p < 0.05. There were no significant differences between groups in demographic characteristics, surgical duration, alignment parameters (mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, component tibial angle, component femoral angle), VAS, OKS, or final ROM. Postoperative (day 0 and day 3) Hb and Hct values did not differ significantly, and no blood transfusions were required in either group. However, same-day discharge was significantly more common in the MMV group (p = 0.02). One wound complication occurred in the MPP group; one patient from each group required postoperative manipulation under anesthesia. While both surgical approaches provided comparable clinical and radiological outcomes with no differences in blood loss, the MMV approach was associated with a higher rate of same-day discharge, suggesting an advantage in early recovery and reduced hospital stay.

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