Minimally Invasive vs. Open Knee Arthroplasty: Effects on Physical Performance and Psychosocial Recovery

Abstract

Moamen Abdelfadil Ismail*, Abdulaziz Abdullah Almasaudi, Amal Yasser Alawami, Anas Ghassan Obaid, Dima Idris Alsahabi, Mustafa Khalid Ahmed, Qussay Alshami, Saleh Ali Almohaimeed, Khalid Jubran Idris, Ahmed Bakr Ibrahim, Zyad Abdulrahman Algolkhof

Background: Total knee arthroplasty (TKA) is a common surgical intervention for end-stage knee osteoarthritis. While traditional open surgery remains standard, minimally invasive surgery (MIS) has emerged as an alternative, aiming to reduce recovery time and postoperative pain. However, the comparative outcomes of MIS versus open TKA, including clinical, functional, and economic metrics, remain debated. This systematic review evaluates existing evidence to compare these approaches.

Methods: A systematic review was conducted following PRISMA guidelines, analyzing studies from 2010 to 2020 retrieved from PubMed, Scopus, Web of Science, and Cochrane Library. Inclusion criteria encompassed comparative studies of MIS and open TKA reporting outcomes such as pain, mobility, complications, and patient satisfaction. Data extraction and quality assessment were performed, with narrative synthesis due to methodological heterogeneity.

Results: Twenty-eight studies were included. MIS demonstrated superior short-term outcomes, including reduced postoperative pain, faster functional recovery (e.g., quadriceps strength and range of motion), and shorter hospital stays. Long-term outcomes, however, were comparable between MIS and open TKA, with no significant differences in patient satisfaction, implant survival, or complication rates. Challenges with MIS included technical difficulties in alignment and a steeper learning curve. Cost analyses revealed mixed results, with MIS reducing hospitalization costs but requiring specialized resources.

Conclusion: MIS offers significant early benefits in TKA, particularly for pain control and rapid recovery, but long-term outcomes align with those of open surgery. The choice of technique should consider patient-specific factors, surgeon expertise, and institutional resources. Further research is needed to standardize MIS protocols and evaluate cost-effectiveness in diverse healthcare settings.