Total knee replacement is a very successful surgical treatment for knee arthritis. Over the years, minimally invasive knee replacement surgical techniques have been developed to lessen tissue trauma and improve patient outcomes. This minimally invasive approach involves much smaller incisions than the usual 10-12 inch incisions used in the traditional knee replacement and spares the quadriceps muscle and tendon, which control bending of the knee, from being cut to access the knee joint.
The smaller incisions with minimally invasive surgery means less tissues are cut resulting in quicker healing and recovery. The potential advantages of minimally invasive joint replacement surgery are:
Minimally invasive surgery for knee replacement involves the use of smaller incisions which are only 4 to 6 inches in length as compared to the 10-12 inch long incision used in the traditional procedure.
Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be lying on your back on the operating table with a tourniquet applied to your upper thigh to reduce blood loss. Your surgeon will then make an incision along the affected knee to expose the knee joint. The surgeon first focuses on the femur (thighbone). The damaged portions of the femur are cut at the appropriate angles using specialized tools. Then the femoral component is attached to the end of the femur with or without bone cement. The next step involves removal of the damaged area of the tibia (shinbone) and the cartilage. It allows for a smooth surface to which implants can be attached. The tibial component is then secured to the end of the bone using bone cement or screws. Your surgeon will place a plastic piece called an articular surface between these implants to ensure a smooth gliding movement. This plastic insert acts in a similar way as the original articular cartilage and helps in supporting your body weight as well as allows the femur bone to move over the tibia. The femur and the tibia bone with their new components are put together to form the new knee joint. To ensure that the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is prepared to receive a plastic component. With all its new components in place, the knee joint is examined through its range of motion. All excess cement will be removed and the entire joint will be irrigated or cleaned out with a sterile saline solution. The incision is then closed and drains are usually inserted. A surgical dressing or bandage is then placed over the incision.
As there is less tissue damage around the knee during the minimally invasive procedure surgery, you can expect a shorter hospital stay, faster recovery and also avoid unsightly smaller surgical scar.
Improvements in technique and surgical instrumentation allow today’s surgeons to insert prosthetic knee joints using shorter skin cuts with less surgical trauma, resulting in fewer days spent in the hospital. These most recent trends in knee replacement surgery focus on improved rehabilitation and pain management to accelerate post-surgery recovery. Employing new surgical techniques to reduce the size of the incision and damage to soft tissue has been the primary advance toward this goal. These techniques are known as MIS or Minimally Invasive Surgery. However, this shouldn’t be confused with keyhole surgery and this procedure is more precisely referred to as a “Reduced Incision Approach.”
Minimally invasive knee replacement accomplishes everything that a traditional knee replacement does via a 4- to 6-inch incision as opposed to an 8- to 10-inch incision.
Although the moniker MIS may suggest a less intense procedure, all knee replacement procedures involve the negotiation through or around muscles and tendons, the cutting of bone from the knee and the attachment of a replacement implant to the bone. MIS does involve a much smaller incision than in conventional knee replacement.
The general idea of knee replacement is the same today as it was decades ago, but we now have better implants, improved instruments, computer navigation technology and robotics, and vastly improved anesthesia techniques that have radically changed joint replacement surgery.
Despite these improvements, there are still some risks with MIS. In experienced hands, these procedures have superb short term outcomes, with faster recovery, less pain, and shorter down time. But not all surgeons can deliver these results.
With limited visibility afforded to the surgeon, MIS techniques do carry a risk of increased complications including sub-optimal device placement. Optimally placed implants trump a fast recovery time when it comes to long-term success. So, if your surgeon has particular interest, training, and experience in MIS knee replacement, then you should discuss the benefits of this technique with him. Otherwise it may be best to stick with traditional techniques, despite the longer recovery time.
You should research the issue, ask questions, speak with your surgeon, carefully weigh your options, before making a decision. In the years to come, implants, surgeons, and techniques will continue to change, delivering more benefits (and associated risk), more promise, and better ultimate outcomes to knee replacement patients.
The term minimally invasive surgery (MIS) has gained currency in recent years due to the advances in surgical methods and computer-assisted medical technology. Doctors, implant companies, and hospitals use the term to refer to several different strategies and procedures. Many of these strategies and procedures are aimed at performing knee replacement through smaller incisions. By reducing the size of the incision, the surgeon is able to reduce the damage to the underlying structure of the knee, which in turn, does less injury to the patient. However, always remember that the size of the incision will be dictated by the size of the implants and the need to be able to manipulate them inside the joint to get the optimal positioning. Getting accurate positioning is key to the success of the entire procedure.
Some of these strategies and procedures closely resemble the existing techniques in knee replacement surgery that have been used for years. Therefore the term can be misleading. An article put out by the University of Missouri-Columbia School of Medicine reads:
“Many of the so-called minimally invasive procedures are simply variations of existing techniques to implant total knees, except that they are done through smaller incisions. Other techniques are genuine advances that go much beyond just making a smaller skin cut. The ultimate goal is not only to make a shorter skin cut, but also to reduce deep muscle trauma associated with surgery, such that pain is lessened, discharge is expedited, and the need for prolonged physical therapy is reduced.”
If your orthopedic surgeon has training and experience in MIS, there can be several advantages to going with this new surgical technique. However, it is important to note that not every patient’s situation will allow for the procedure. In the case where the surgeon is experienced and the patient’s situation allows for MIS, then this may be an option to consider.
Dr. kirthi Paladugu, “In experienced hands, these procedures have superb short term outcomes, with faster recovery, less pain, and shorter down time. But not all surgeons can deliver these results. Research the issue, ask questions, speak with your surgeon, carefully weigh your options, ask more questions, kick the tires, and make a decision.”
Clearly, the advantages of MIS knee replacement surgery involve short-term results. This includes an “earlier discharge from the hospital, less pain, and a faster return to day-to-day activities” (University of Missouri-Columbia School of Medicine). In addition, “The need for physical therapy following surgery is minimized by techniques that reduce trauma to the skin, muscles, and tendons” (U of M-C).
While MIS surgical procedures may reduce some risks and complications associated with traditional knee replacements, they may also introduce new ones. MIS is by no means “risk-free”. Nevertheless, the new techniques, causing less injury to the body, a shortened recovery time, and greater short-term results, continue to position MIS as a method of surgery worth considering.
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