Minimally Invasive Total Knee Replacement


Total knee replacement (also called knee arthroplasty) is a common orthopaedic procedure that is used to replace the damaged or worn surfaces of the knee. Replacing these surfaces with an implant or “prosthesis” will relieve pain and increase mobility, allowing you to return to your normal, everyday activities.


The traditional approach to knee replacement uses a long vertical incision in the center of the knee to view and access the joint. Minimally invasive total knee replacement is a variation of this approach. The surgeon uses a shorter incision and a different, less-invasive technique to expose the joint—with the goal of reducing postoperative pain and speeding recovery.


Description


Minimally Invasive Knee Replacement


In minimally invasive knee replacement, the surgical procedure is similar, but there is less cutting of the tissue surrounding the knee. The artificial implants used are the same as those used for traditional knee replacement. However, specially designed surgical instruments are used to prepare the femur and tibia and to place the implants properly.


Minimally invasive knee replacement is performed through a shorter incision—4 to 6 inches versus 8 to 10 inches for traditional knee replacement. A smaller incision allows for less tissue disturbance.


In addition to a shorter incision, the technique used to open the knee is less invasive. In general, techniques used in minimally invasive knee replacement are “quadriceps sparing,” meaning they avoid trauma to the quadriceps tendon and muscles in the front of the thigh. Other minimally invasive techniques called “midvastus” and “subvastus” make small incisions in the muscle but are also less invasive than traditional knee replacement. Because the techniques used to expose the joint involve less disruption to the muscle, it may lead to less postoperative pain and reduced recovery time.


The hospital stay after minimally invasive surgery is similar in length to the stay after traditional knee replacement surgery–ranging from 1 to 4 days. Physical rehabilitation is a critical component of recovery. Your surgeon or a physical therapist will provide you with specific exercises to help increase your range of motion and restore your strength.


The main potential benefits of this new technique include:



  1. More rapid return of knee function. Patients who undergo this procedure seem to get muscle strength and control back more quickly than patients who have had traditional total knee replacement. This is because the quadriceps muscle and tendon are not divided in the course of the surgical exposure like in traditional knee replacement and the kneecap is not everted (flipped out of the way) as it is in traditional total knee replacement.

  2. Smaller incision. While this procedure would not be worth performing for cosmetic benefits many patients do prefer the shorter incision. Traditional knee replacement incisions often measure 8” or longer; minimally-invasive quadriceps-sparing knee replacement incisions are about 4” in length for most patients.

  3. Decreased post-operative pain. This may be a function of the smaller incision and the fact that the incision stays out of the important quadriceps muscle/tendon group.

  4. Same reliable surgical implants as Traditional Knee Replacement. Much has been learned about implant design in the nearly 40-year history of contemporary knee replacement. Minimally-invasive quadriceps-sparing total knee replacement is an evolution of surgical technique which permits the use of time-tested implant designs. This gives some reassurance that while the surgical approach is new the implants themselves have a good proven track record.


Candidates for Minimally Invasive Total Knee Replacement


Minimally invasive total knee replacement is not suitable for all patients. Your doctor will conduct a thorough evaluation and consider several factors before determining if the procedure is an option for you.


In general, candidates for minimal incision procedures are thinner, younger, healthier and more motivated to participate in the rehabilitation process, compared with patients who undergo the traditional surgery.


Minimally invasive surgeries may be less suitable for patients who are overweight or who have already undergone other knee surgeries.


In addition, patients who have a significant deformity of the knee, those who are very muscular, and those with health problems that may slow wound healing may be at a higher risk for problems from minimally invasive total knee replacement.


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