Expert consensus on clinical pathway for high-conformity total knee arthroplasty through a minimally invasive surgical approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 Expert Consensus Development Group on Clinical Pathways for High-Conformity Total Knee Arthroplasty Through a Minimally Invasive Surgical Approach ,  Project Team of the “Application Demonstration of Laser Additive Manufacturing for High-Conformity Total Knee Arthroplasty”, a Key Project under the National Key Research and Development Program of China for “Additive Manufacturing and Laser Manufacturing” (Fiscal Year 2023) ,  , 

Corresponding?author：

Expert Consensus Development Group on Clinical Pathways for High-Conformity Total Knee Arthroplasty Through a Minimally Invasive Surgical Approach, Email: xiaowenfeng@csu.edu.cn; Project Team of the “Application Demonstration of Laser Additive Manufacturing for High-Conformity Total Knee Arthroplasty”, a Key Project under the National Key Research and Development Program of China for “Additive Manufacturing and Laser Manufacturing” (Fiscal Year 2023), Email: liyusheng@csu.edu.cn; , Email: greatli2000@163.com; , Email: shenbin71@hotmail.com

Keywords：

Total knee arthroplasty; high-conformity prostheses; minimally invasive approach; clinical pathway

DOI：

10.7507/1002-1892.202607056

Video：

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With the growing demand for total knee arthroplasty (TKA) in patients with end-stage knee osteoarthritis, the integration of minimally invasive surgical concepts with high-conformity personalized prosthesis design has become an important strategy for improving surgical precision and postoperative outcomes. However, standardized clinical pathway guidance for this combined approach remains lacking. Therefore, based on the current body of evidence and through multicenter expert collaboration, this consensus aims to establish a standardized clinical application protocol. The consensus focuses on the technical characteristics of high-conformity prostheses and the principles of mechanical alignment, and systematically develops a comprehensive clinical pathway covering preoperative digital planning, intraoperative precision techniques, and postoperative rehabilitation and follow-up. By standardizing patient selection criteria, refining imaging-based modeling and individualized prosthesis design procedures, optimizing osteotomy accuracy and soft tissue preservation under minimally invasive conditions, and establishing a follow-up system centered on functional baseline comparison and image-based matching verification, this consensus ultimately proposes a closed loop quality management framework spanning preoperative assessment, intraoperative implementation, and postoperative evaluation. It is expected to provide practical guidance for the safe and effective clinical application of high-conformity TKA performed through minimally invasive approaches.

Citation： Expert Consensus Development Group on Clinical Pathways for High-Conformity Total Knee Arthroplasty Through a Minimally Invasive Surgical Approach, Project Team of the “Application Demonstration of Laser Additive Manufacturing for High-Conformity Total Knee Arthroplasty”, a Key Project under the National Key Research and Development Program of China for “Additive Manufacturing and Laser Manufacturing” (Fiscal Year 2023). Expert consensus on clinical pathway for high-conformity total knee arthroplasty through a minimally invasive surgical approach. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1336-1345. doi: 10.7507/1002-1892.202607056 Copy

1.	GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990—2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet Rheumatol, 2023, 5(9): e508-e522.
2.	Shichman I, Roof M, Askew N, et al. Projections and epidemiology of primary hip and knee arthroplasty in medicare patients to 2040-2060[J/OL]. JB JS Open Access, 2023, 8(1). doi: 10.2106/JBJS.OA.22.00112.
3.	中華醫學會骨科學分會關節外科學組, 中國醫師協會骨科醫師分會骨關節炎學組, 國家老年疾病臨床醫學研究中心(湘雅醫院), 等. 中國骨關節炎診療指南 (2021年版)[J]. 中華骨科雜志, 2021, 41(18): 1291-1314.
4.	Morrell AT, Layon DR, Scott MJ, et al. Enhanced recovery after primary total hip and knee arthroplasty: A systematic review[J]. J Bone Joint Surg (Am), 2021, 103(20): 1938-1947.
5.	Migliorini F, Eschweiler J, Baroncini A, et al. Better outcomes after minimally invasive surgeries compared to the standard invasive medial parapatellar approach for total knee arthroplasty: a meta-analysis[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(11): 3608-3620.
6.	Bonnin MP, Beckers L, Leon A, et al. Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2): 464-475.
7.	Figueroa D, Figueroa F, Guiloff R, et al. New technology: Custom made implants, patient-specific alignment, and navigation—How to convince my hospital it’s worth it: Current concepts[J/OL]. J ISAKOS, 2024, 9(6): 100339. doi: 10.1016/j.jisako.2024.100339.
8.	Wainwright TW. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS^?) Society recommendations[J/OL]. Acta Orthop, 2020, 91(3): 363. doi: 10.1080/17453674.2020.1724674.
9.	Srivastava AK, Surgical Management of Osteoarthritis of the Knee Work Group, Staff of the American Academy of Orthopaedic Surgeons. American academy of orthopaedic surgeons clinical practice guideline summary of surgical management of osteoarthritis of the knee[J]. J Am Acad Orthop Surg, 2023, 31(24): 1211-1220.
10.	中華醫學會骨科學分會關節外科學組, 北京醫學會骨科專業委員會關節外科學組. 中國全膝關節置換術圍手術期疼痛管理指南 (2022)[J]. 協和醫學雜志, 2022, 13(6): 965-985.
11.	中華醫學會骨科學分會關節學組. 中國髖、膝關節置換日間手術圍手術期管理專家共識[J]. 中華老年骨科與康復電子雜志, 2023, 9(6): 321-332.
12.	Hannon CP, Goodman SM, Austin MS, et al. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons clinical practice guideline for the optimal timing of elective hip or knee arthroplasty for patients with symptomatic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy is ineffective[J]. J Arthroplasty, 2023, 38(11): 2193-2201.
13.	中華醫學會骨科學分會關節外科學組. 髖膝關節置換手術止血中國專家共識[J/OL]. 中華關節外科雜志 (電子版), 2025, 19(2): 131-142. doi: 10.3877/cma.j.issn.1674-134X.2025.02.001.
14.	中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南[J]. 中華骨科雜志, 2016, 36(2): 65-71.
15.	Schippers P, Wunderlich F, Afghanyar Y, et al. High patient satisfaction with Customized Total Knee Arthroplasty at five year follow-up[J]. Int Orthop, 2024, 48(12): 3101-3108.
16.	Roy AE, Mestriner AB, Antonelli B, et al. Early results of a patient-specific total knee arthroplasty implant cast from a 3D-printed mold[J/OL]. Arthroplast Today, 2024, 30: 101558. doi: 10.1016/j.artd.2024.101558.
17.	王安民, 宋長輝, 楊永強, 等. 膝關節股骨假體的個性化設計與匹配程度分析[J]. 計算機輔助設計與圖形學學報, 2018, 30(8): 1572-1578.
18.	Kaszuba SV, Hurley M, Beitler BG, et al. A review of the design, manufacture, and outcomes of custom total joint replacement implants available in the United States[J/OL]. J Clin Orthop Trauma, 2024, 49: 102354. doi: 10.1016/j.jcot.2024.102354.
19.	國家藥品監督管理局. 增材制造匹配式人工膝關節假體獲批上市[EB/OL]. 國家藥品監督管理局網站, 2023-11-17. https://www.nmpa.gov.cn/zhuanti/cxylqx/cxylqxlm/20231117171250166.html.
20.	Oussedik S, Abdel MP, Victor J, et al. Alignment in total knee arthroplasty[J]. Bone Joint J, 2020, 102-B(3): 276-279.
21.	Hernandez NM, Wu CJ, Hinton ZW, et al. Primary total knee arthroplasty in patients aged 45 years or younger: 162 total knee arthroplasties with a mean follow-up duration of 7 years[J]. Arthroplast Today, 2022, 18: 163-167.
22.	Yoo J, Oh H, Park S, et al. Does obesity affect clinical and radiological outcomes in minimally invasive total knee arthroplasty? Minimum 5-year follow-up of minimally invasive TKA in obese patients[J]. Clin Orthop Surg, 2018, 10(3): 315-321.
23.	Yoo JH, Park SH, Han CD, et al. Radiologic outcomes according to varus deformity in minimally invasive surgery total knee arthroplasty[J]. Yonsei Med J, 2016, 57(1): 225-231.
24.	Beckers G, Kiss M, Massé V, et al. Personalized total knee arthroplasty in patients with extra-articular deformities[J]. EFORT Open Rev, 2024, 9(7): 646-657.
25.	Duong V, Oo WM, Ding C, et al. Evaluation and treatment of knee pain: A review[J]. JAMA, 2023, 330(16): 1568-1580.
26.	Aglietti P, Baldini A, Giron F, et al. Minimally invasive total knee arthroplasty: is it for everybody?[J]. HSS J, 2006, 2(1): 22-26.
27.	Picard F, Deakin A, Balasubramanian N, et al. Minimally invasive total knee replacement: techniques and results[J]. Eur J Orthop Surg Traumatol, 2018, 28(5): 781-791.
28.	Shao L, Wu X, Liu Y, et al. No difference between CT- and MRI-based patient-specific instrumentation for total knee arthroplasty: an updated systematic review and meta-analysis[J/OL]. Front Bioeng Biotechnol, 2025, 13: 1624600. doi: 10.3389/fbioe.2025.1624600.
29.	Hafez MA, Jansen A, Portheine F, et al. Laboratory validation of patient-specific templating for total knee arthroplasty[J/OL]. Sci Rep, 2025, 15(1): 1577. doi: 10.1038/s41598-024-77794-9.
30.	Michalska-Foryszewska A, Modzelewski P, Sklinda K, et al. Radiological approach to assessment of lower-limb alignment-coronal and transverse plane analysis[J/OL]. J Clin Med, 2024, 13(22). doi: 10.3390/jcm13226975.
31.	Park J, Chang MJ, Kim TW, et al. Serial changes in patient-reported outcome measures and satisfaction rate during long-term follow-up after total knee arthroplasty: a systematic review and meta-analysis[J/OL]. Knee Surg Relat Res, 2024, 36(1): 43. doi: 10.1186/s43019-024-00241-6.
32.	Punnoose A, Claydon-Mueller LS, Weiss O, et al. Prehabilitation for patients undergoing orthopedic surgery: A systematic review and meta-analysis[J/OL]. JAMA Netw Open, 2023, 6(4): e238050. doi: 10.1001/jamanetworkopen.2023.8050.
33.	Daghistani M, Alharb S, Almohammadi T, et al. The subvastus approach for total knee arthroplasty in obese patients: A systematic review[J]. Journal of Healthcare Sciences, 2025, 5(1): 13-23.
34.	Stubnya BG, Kocsis K, Váncsa S, et al. Subvastus approach supporting fast-track total knee arthroplasty over the medial parapatellar approach: A systematic review and network meta-analysis[J]. J Arthroplasty, 2023, 38(12): 2750-2758.
35.	Bouché P, Corsia S, Nizard R, et al. Comparative efficacy of the different surgical approaches in total knee arthroplasty: A systematic-review and network meta-analysis[J]. J Arthroplasty, 2021, 36(3): 1187.e1-1194.e1.
36.	Katragadda B, Kumar S, Suresh A, et al. Midvastus versus medial parapatellar approach in simultaneous bilateral total knee arthroplasty[J]. J Arthroplasty, 2023, 38(11): 2301-2306.
37.	Hu W, Nie Y, Li Y, et al. A modified minimally invasive subvastus approach shows superior early postoperative clinical outcomes compared to the medial parapatellar approach in total knee arthroplasty for osteoarthritis patients: a comparative study[J/OL]. BMC Musculoskelet Disord, 2025, 26(1): 1117. doi: 10.1186/s12891-025-09428-8.
38.	Wang Y, Wu S, Chen C, et al. Compare the quadriceps activity between mini-midvastus and mini-medial parapatellar approach in total knee arthroplasty with electromyography[J/OL]. J Clin Med, 2024, 13(10). doi: 10.3390/jcm13102736.
39.	Yuan F, Sun Z, Fu J, et al. Do minimally invasive approaches affect long-term clinical outcomes of total knee arthroplasty? A cohort analysis with a minimum 10-year follow-up[J]. Chin Med J (Engl), 2023, 136(11): 1376-1378.
40.	Khan MNH, Abbas K, Faraz A, et al. Total knee replacement: A comparison of the subvastus and medial parapatellar approaches[J/OL]. Ann Med Surg (Lond), 2021, 68: 102670. doi: 10.1016/j.amsu.2021.102670.
41.	Xiang-Sheng T, Hu Z, Lei C, et al. Stretching force of incision affects early clinical results after primary total knee arthroplasty: A retrospective study[J]. Orthop Surg, 2021, 13(1): 237-243.
42.	Elsenosy AM, Hassan E, Yousef AS, et al. 3D-printed patient-specific instrumentation versus conventional techniques in total knee arthroplasty: A systematic review and meta-analysis[J/OL]. Cureus, 2025, 17(10): e94626. doi: 10.7759/cureus.94626.
43.	Nam JH, Koh YG, Kang K, et al. The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty[J/OL]. J Orthop Surg Res, 2020, 15(1): 603. doi: 10.1186/s13018-020-02146-y.
44.	Moret CS, Schelker BL, Hirschmann MT. Clinical and radiological outcomes after knee arthroplasty with patient-specific versus off-the-shelf knee implants: A systematic review[J/OL]. J Pers Med, 2021, 11(7). doi: 10.3390/jpm11070590.
45.	Van Egmond JC, Hesseling B, Verburg H, et al. Short-term functional outcome after fast-track primary total knee arthroplasty: analysis of 623 patients[J]. Acta Orthop, 2021, 92(5): 602-607.
46.	Momoli A, Giarretta S, Modena M, et al. The painful knee after total knee arthroplasty: evaluation and management[J]. Acta Biomed, 2017, 88(2S): 60-67.
47.	Wilson I, Bohm E, Lübbeke A, et al. Orthopaedic registries with patient-reported outcome measures[J]. EFORT Open Rev, 2019, 4(6): 357-367.

1. GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990—2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet Rheumatol, 2023, 5(9): e508-e522.
2. Shichman I, Roof M, Askew N, et al. Projections and epidemiology of primary hip and knee arthroplasty in medicare patients to 2040-2060[J/OL]. JB JS Open Access, 2023, 8(1). doi: 10.2106/JBJS.OA.22.00112.
3. 中華醫學會骨科學分會關節外科學組, 中國醫師協會骨科醫師分會骨關節炎學組, 國家老年疾病臨床醫學研究中心(湘雅醫院), 等. 中國骨關節炎診療指南 (2021年版)[J]. 中華骨科雜志, 2021, 41(18): 1291-1314.
4. Morrell AT, Layon DR, Scott MJ, et al. Enhanced recovery after primary total hip and knee arthroplasty: A systematic review[J]. J Bone Joint Surg (Am), 2021, 103(20): 1938-1947.
5. Migliorini F, Eschweiler J, Baroncini A, et al. Better outcomes after minimally invasive surgeries compared to the standard invasive medial parapatellar approach for total knee arthroplasty: a meta-analysis[J]. Knee Surg Sports Traumatol Arthrosc, 2021, 29(11): 3608-3620.
6. Bonnin MP, Beckers L, Leon A, et al. Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2): 464-475.
7. Figueroa D, Figueroa F, Guiloff R, et al. New technology: Custom made implants, patient-specific alignment, and navigation—How to convince my hospital it’s worth it: Current concepts[J/OL]. J ISAKOS, 2024, 9(6): 100339. doi: 10.1016/j.jisako.2024.100339.
8. Wainwright TW. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS^?) Society recommendations[J/OL]. Acta Orthop, 2020, 91(3): 363. doi: 10.1080/17453674.2020.1724674.
9. Srivastava AK, Surgical Management of Osteoarthritis of the Knee Work Group, Staff of the American Academy of Orthopaedic Surgeons. American academy of orthopaedic surgeons clinical practice guideline summary of surgical management of osteoarthritis of the knee[J]. J Am Acad Orthop Surg, 2023, 31(24): 1211-1220.
10. 中華醫學會骨科學分會關節外科學組, 北京醫學會骨科專業委員會關節外科學組. 中國全膝關節置換術圍手術期疼痛管理指南 (2022)[J]. 協和醫學雜志, 2022, 13(6): 965-985.
11. 中華醫學會骨科學分會關節學組. 中國髖、膝關節置換日間手術圍手術期管理專家共識[J]. 中華老年骨科與康復電子雜志, 2023, 9(6): 321-332.
12. Hannon CP, Goodman SM, Austin MS, et al. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons clinical practice guideline for the optimal timing of elective hip or knee arthroplasty for patients with symptomatic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy is ineffective[J]. J Arthroplasty, 2023, 38(11): 2193-2201.
13. 中華醫學會骨科學分會關節外科學組. 髖膝關節置換手術止血中國專家共識[J/OL]. 中華關節外科雜志 (電子版), 2025, 19(2): 131-142. doi: 10.3877/cma.j.issn.1674-134X.2025.02.001.
14. 中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南[J]. 中華骨科雜志, 2016, 36(2): 65-71.
15. Schippers P, Wunderlich F, Afghanyar Y, et al. High patient satisfaction with Customized Total Knee Arthroplasty at five year follow-up[J]. Int Orthop, 2024, 48(12): 3101-3108.
16. Roy AE, Mestriner AB, Antonelli B, et al. Early results of a patient-specific total knee arthroplasty implant cast from a 3D-printed mold[J/OL]. Arthroplast Today, 2024, 30: 101558. doi: 10.1016/j.artd.2024.101558.
17. 王安民, 宋長輝, 楊永強, 等. 膝關節股骨假體的個性化設計與匹配程度分析[J]. 計算機輔助設計與圖形學學報, 2018, 30(8): 1572-1578.
18. Kaszuba SV, Hurley M, Beitler BG, et al. A review of the design, manufacture, and outcomes of custom total joint replacement implants available in the United States[J/OL]. J Clin Orthop Trauma, 2024, 49: 102354. doi: 10.1016/j.jcot.2024.102354.
19. 國家藥品監督管理局. 增材制造匹配式人工膝關節假體獲批上市[EB/OL]. 國家藥品監督管理局網站, 2023-11-17. https://www.nmpa.gov.cn/zhuanti/cxylqx/cxylqxlm/20231117171250166.html.
20. Oussedik S, Abdel MP, Victor J, et al. Alignment in total knee arthroplasty[J]. Bone Joint J, 2020, 102-B(3): 276-279.
21. Hernandez NM, Wu CJ, Hinton ZW, et al. Primary total knee arthroplasty in patients aged 45 years or younger: 162 total knee arthroplasties with a mean follow-up duration of 7 years[J]. Arthroplast Today, 2022, 18: 163-167.
22. Yoo J, Oh H, Park S, et al. Does obesity affect clinical and radiological outcomes in minimally invasive total knee arthroplasty? Minimum 5-year follow-up of minimally invasive TKA in obese patients[J]. Clin Orthop Surg, 2018, 10(3): 315-321.
23. Yoo JH, Park SH, Han CD, et al. Radiologic outcomes according to varus deformity in minimally invasive surgery total knee arthroplasty[J]. Yonsei Med J, 2016, 57(1): 225-231.
24. Beckers G, Kiss M, Massé V, et al. Personalized total knee arthroplasty in patients with extra-articular deformities[J]. EFORT Open Rev, 2024, 9(7): 646-657.
25. Duong V, Oo WM, Ding C, et al. Evaluation and treatment of knee pain: A review[J]. JAMA, 2023, 330(16): 1568-1580.
26. Aglietti P, Baldini A, Giron F, et al. Minimally invasive total knee arthroplasty: is it for everybody?[J]. HSS J, 2006, 2(1): 22-26.
27. Picard F, Deakin A, Balasubramanian N, et al. Minimally invasive total knee replacement: techniques and results[J]. Eur J Orthop Surg Traumatol, 2018, 28(5): 781-791.
28. Shao L, Wu X, Liu Y, et al. No difference between CT- and MRI-based patient-specific instrumentation for total knee arthroplasty: an updated systematic review and meta-analysis[J/OL]. Front Bioeng Biotechnol, 2025, 13: 1624600. doi: 10.3389/fbioe.2025.1624600.
29. Hafez MA, Jansen A, Portheine F, et al. Laboratory validation of patient-specific templating for total knee arthroplasty[J/OL]. Sci Rep, 2025, 15(1): 1577. doi: 10.1038/s41598-024-77794-9.
30. Michalska-Foryszewska A, Modzelewski P, Sklinda K, et al. Radiological approach to assessment of lower-limb alignment-coronal and transverse plane analysis[J/OL]. J Clin Med, 2024, 13(22). doi: 10.3390/jcm13226975.
31. Park J, Chang MJ, Kim TW, et al. Serial changes in patient-reported outcome measures and satisfaction rate during long-term follow-up after total knee arthroplasty: a systematic review and meta-analysis[J/OL]. Knee Surg Relat Res, 2024, 36(1): 43. doi: 10.1186/s43019-024-00241-6.
32. Punnoose A, Claydon-Mueller LS, Weiss O, et al. Prehabilitation for patients undergoing orthopedic surgery: A systematic review and meta-analysis[J/OL]. JAMA Netw Open, 2023, 6(4): e238050. doi: 10.1001/jamanetworkopen.2023.8050.
33. Daghistani M, Alharb S, Almohammadi T, et al. The subvastus approach for total knee arthroplasty in obese patients: A systematic review[J]. Journal of Healthcare Sciences, 2025, 5(1): 13-23.
34. Stubnya BG, Kocsis K, Váncsa S, et al. Subvastus approach supporting fast-track total knee arthroplasty over the medial parapatellar approach: A systematic review and network meta-analysis[J]. J Arthroplasty, 2023, 38(12): 2750-2758.
35. Bouché P, Corsia S, Nizard R, et al. Comparative efficacy of the different surgical approaches in total knee arthroplasty: A systematic-review and network meta-analysis[J]. J Arthroplasty, 2021, 36(3): 1187.e1-1194.e1.
36. Katragadda B, Kumar S, Suresh A, et al. Midvastus versus medial parapatellar approach in simultaneous bilateral total knee arthroplasty[J]. J Arthroplasty, 2023, 38(11): 2301-2306.
37. Hu W, Nie Y, Li Y, et al. A modified minimally invasive subvastus approach shows superior early postoperative clinical outcomes compared to the medial parapatellar approach in total knee arthroplasty for osteoarthritis patients: a comparative study[J/OL]. BMC Musculoskelet Disord, 2025, 26(1): 1117. doi: 10.1186/s12891-025-09428-8.
38. Wang Y, Wu S, Chen C, et al. Compare the quadriceps activity between mini-midvastus and mini-medial parapatellar approach in total knee arthroplasty with electromyography[J/OL]. J Clin Med, 2024, 13(10). doi: 10.3390/jcm13102736.
39. Yuan F, Sun Z, Fu J, et al. Do minimally invasive approaches affect long-term clinical outcomes of total knee arthroplasty? A cohort analysis with a minimum 10-year follow-up[J]. Chin Med J (Engl), 2023, 136(11): 1376-1378.
40. Khan MNH, Abbas K, Faraz A, et al. Total knee replacement: A comparison of the subvastus and medial parapatellar approaches[J/OL]. Ann Med Surg (Lond), 2021, 68: 102670. doi: 10.1016/j.amsu.2021.102670.
41. Xiang-Sheng T, Hu Z, Lei C, et al. Stretching force of incision affects early clinical results after primary total knee arthroplasty: A retrospective study[J]. Orthop Surg, 2021, 13(1): 237-243.
42. Elsenosy AM, Hassan E, Yousef AS, et al. 3D-printed patient-specific instrumentation versus conventional techniques in total knee arthroplasty: A systematic review and meta-analysis[J/OL]. Cureus, 2025, 17(10): e94626. doi: 10.7759/cureus.94626.
43. Nam JH, Koh YG, Kang K, et al. The posterior cortical axis as an alternative reference for femoral component placement in total knee arthroplasty[J/OL]. J Orthop Surg Res, 2020, 15(1): 603. doi: 10.1186/s13018-020-02146-y.
44. Moret CS, Schelker BL, Hirschmann MT. Clinical and radiological outcomes after knee arthroplasty with patient-specific versus off-the-shelf knee implants: A systematic review[J/OL]. J Pers Med, 2021, 11(7). doi: 10.3390/jpm11070590.
45. Van Egmond JC, Hesseling B, Verburg H, et al. Short-term functional outcome after fast-track primary total knee arthroplasty: analysis of 623 patients[J]. Acta Orthop, 2021, 92(5): 602-607.
46. Momoli A, Giarretta S, Modena M, et al. The painful knee after total knee arthroplasty: evaluation and management[J]. Acta Biomed, 2017, 88(2S): 60-67.
47. Wilson I, Bohm E, Lübbeke A, et al. Orthopaedic registries with patient-reported outcome measures[J]. EFORT Open Rev, 2019, 4(6): 357-367.

Chinese Journal of Reparative and Reconstructive Surgery

Expert consensus on clinical pathway for high-conformity total knee arthroplasty through a minimally invasive surgical approach

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