Minimally invasive total knee arthroplasty (TKA) has the potential to reduce postoperative pain and improve recovery time. We followed prospectively 209 patients who underwent TKA through a quadriceps-sparing median parapatellar approach. Surgical complications included 2 patellar tendon avulsions, 2 lateral collateral ligament ruptures, and 1 medial collateral ligament rupture. Arthrofibrosis occurred in 21 patients (10%) requiring manipulation under anesthesia, and minor wound complications occurred in 22 patients (11%). Unintended cement retention was noted on 16 (8%) postoperative radiographs. At 6-month follow-up, Knee Society scores and functional outcomes were unchanged from our previous experience.
Compared to previous experience with traditional medial parapatellar approaches, the rate of intraoperative complications such as ligament rupture, wound compromise, and retention of cement were higher than expected. Complication rates in the second 100 patients showed no significant difference compared to our traditional incision patients. This technique required a progressive learning curve and has not yet proven to be superior to standard approaches. However, complication rates after extensive experience were not significantly increased.