Medial parapatellar (MPP) remains the classical and preferred approach for TKA. Apart from MPP, options include the mini-medial parapatellar (MMPP), mini-subvastus (MSV), mini-midvastus (MMV), and quadriceps-sparing (QS) approaches.

Data from 4,500 patients was collected to compare and contrast the various methods used and the relative outcomes for the patients concerned. The research revealed a number of constituents of what could be considered a successful outcome, such as length of hospital stay, blood loss, recovery time, ease of use, accuracy and other variables. The idea, of course, with the minimally invasive techniques is to reduce the hospital stay and to provide a quicker recovery for the patient.

The popular MPP method involves exposure of the knee surfaces, allowing surgeons to see exactly what they are doing and where they are positioning the new components. The minimally invasive nature of other methods may discourage some surgeons as there are visibility and augmented difficulties when installing new joints, which can lead to misplacement. Implant malposition can relate to instability, loosening and consequent joint failure. Nonetheless, effective and accurate minimally invasive surgery does seem to provide the best overall outcomes for most patients.

The study concluded that that the mini-subvastus method for total knee arthroplasty is probably the best of the options overall, considering all of the variables. However, further studies are being undertaken to consider the needs of both surgeon and patient to offer a clearer picture about which of the currently available procedures is preferable.