Introduction: There is an ongoing discussion about potential risks and benefits of minimally invasive approaches (MIS) in total joint replacement. The aim of this study was to evaluate, whether a higher incidence of misalignments could be observed after minimally invasive navigated TKA and whether the results in the early postoperative period were better compared to standard approaches.

Methods: A total of 50 patients were treated with a navigated (OrthoPilot 4.2) Columbus knee prosthesis (BBraun Aesculap, Tuttlingen, Germany). In 25 patients either a standard or a minimally invasive (mini-mid-vastus) approach was carried out. In both groups the same exclusion criteria for MIS were adopted. Initially during surgery (Nav1a) and finally after implantation of the original components (Nav1b) the mechanical leg axis, passive range of motion and stability were measured by navigation according the common workflow of the system. After restarting the software the same parameters were evaluated once more in a second procedure (Nav2) by reacquisition of joint centres both kinematically and by anatomical landmark palpation with the original prosthesis already implanted. Nav2 was conducted independently from the initial surgical procedure. To validate the intraoperative measurements additional pre- and postoperative long-leg-standing radiographs were made. During the first 10 days postoperatively daily range of motion (ROM) and pain (VAS) were measured. Perioperative blood loss and complications were documented. Results were analyzed by student’s t-test.

Results: Both groups were comparable with regards to preoperative demographic, radiological and intraoperative data (Nav1a). There were no significant differences between the groups concerning intraoperative measurements of mechanical leg axis, passive range of motion and stability by Nav1b and Nav2. Additionally no differences were found for the alignment in the postoperative radiographs. The length of the skin incision was significantly shorter in the minimally invasive group. Postoperative ROM was significantly higher and pain was significantly less intensive in the MIS group. Blood loss and complication rates were comparable.

Discussion: If the exclusion criteria for MIS were accepted no differences regarding the quality of alignment, passive range of motion and ligament stability could be demonstrated between conventional and MIS navigated TKA. Patients with MIS navigated TKA performed superior in terms of early postoperative function and pain. From the authors point of view the technically demanding minimally invasive implantation of the knee prosthesis should be exclusively performed with support of navigation.

The video shows the detailed surgical technique of minimally invasive navigated total knee arthroplasty. A Columbus (BBraun Aesculap, Tuttlingen, Germany) total knee prosthesis is implanted using the OrthoPilot navigated system and the specially designed small MIOS instruments (BBraun Aesculap, Tuttlingen, Germany). A mini-mid-vastus approach is carried out with an 8 cm skin incision.