Anterolateral skin incision for total knee arthroplasty is associated with lower prevalence of postoperative hypoesthesia at 1-year: a meta-analysis of randomised trials

Omar E S Mostafa; Eden E S Mostafa; Tahir Khaleeq; Osama Aweid; Loiy Alkhatib; Amit Meena; Bolarinwa Akinola; Usman Ahmed; Shahbaz S Malik

doi:10.1016/j.knee.2026.104345

Anterolateral skin incision for total knee arthroplasty is associated with lower prevalence of postoperative hypoesthesia at 1-year: a meta-analysis of randomised trials

Knee. 2026 Jan 23:60:104345. doi: 10.1016/j.knee.2026.104345. Online ahead of print.

Authors

Omar E S Mostafa¹, Eden E S Mostafa², Tahir Khaleeq³, Osama Aweid⁴, Loiy Alkhatib⁵, Amit Meena⁶, Bolarinwa Akinola⁷, Usman Ahmed⁸, Shahbaz S Malik⁹

Affiliations

¹ Birmingham Orthopaedic Training Programme, Birmingham, UK; The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK. Electronic address: Omar.mostafa1@nhs.net.
² University of Birmingham, Birmingham, UK.
³ Birmingham Orthopaedic Training Programme, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁴ Fortius Clinic, London, UK; Broomfield Hospital, Mid and South Essex NHS Trust, Chelmsford, UK.
⁵ Dr. Suleiman AlHabib Hospital Dubai Health Care City (DHCC), Dubai, United Arab Emirates.
⁶ Shalby Multi-Specialty Hospital, Jaipur, Rajasthan, India.
⁷ Osteon Clinics, Lagos, Nigeria.
⁸ Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
⁹ Worcestershire Acute Hospitals NHS Trust, Worcester, UK; Birmingham Knee School, Birmingham, UK.

PMID: 41579457
DOI: 10.1016/j.knee.2026.104345

Abstract

Background: A meta-analysis of randomised trials was conducted to compare clinical and functional outcomes between the standard anteromedial or midline skin incision and unconventional anterolateral incision for total knee arthroplasty (TKA).

Methods: This study was registered prospectively on the INPLASY database. Literature search was performed on 14th December 2024 in accordance with PRISMA. Only randomised controlled trials (RCTs) comparing anterolateral incision (ALI) versus standard (midline or anteromedial) incision (SI) were included and quality-assessed. Outcomes at 1 year postoperatively were prevalence of numbness, surface area of skin numbness, degrees of knee flexion, Visual Analogue Scale (VAS), Forgotten Joint Score (FJS) and Knee Injury and Osteoarthritis Outcome Score (KOOS).

Results: Eight RCTs totalling 609 patients (ALI 276 vs. SI 333) were included. Mean age, BMI and proportion of male patients were comparable between the two groups. There was no baseline difference between the two groups for the incision length or operative duration. Statistical difference was observed for two outcomes favouring the ALI group: prevalence of hypoesthesia (OR 0.36, CI 0.17-0.77, P = 0.008) and surface area of numbness (SMD -1.04, CI -1.80 to -0.28, P = 0.007). No significant difference was observed in KOOS (SMD 0.16, CI - 0.07 to revman 0.38, P = 0.17), FJS (SMD -0.14, CI -0.39 to 0.12, P = 0.30) and VAS (SMD -0.10, CI -0.39 to 0.20, P = 0.51).

Conclusion: An anterolateral incision to TKA results in a lower rate and smaller surface area of numbness at 1-year, with no difference in patient-reported outcome measures.

Keywords: Arthroplasty; Incision; Lateral; Numbness.

Publication types

Review