Total knee replacement has been a successful procedure for the treatment of end-stage, severe knee arthritis. According to clinical studies, long-term results for functional improvement and pain relief are excellent using total knee replacement. However, the traditional approach to knee replacement requires a large incision and a long recovery period. Many patients suffer from permanent quadriceps weakness after knee replacement.
The mini-incision technique, also called minimally invasive total knee replacement, is an alternative to total knee arthroplasty (TKA). The minimally invasive procedure is a true quadriceps-sparing surgery. The proposed benefits of the mini-incision procedure include:
- Gain of early knee flexion (bending)
- Decreased pain and need for analgesics
- Improved quadriceps function
- Decreased blood loss
- Shortened length of hospital stay
- Cosmetically better smaller incision
- Early recovery
- Rapid rehabilitation
To evaluate the short-term clinical and functional outcome of minimally invasive surgery TKA compared to traditional total knee replacement, researchers evaluated 80 knees. They found that patients in the minimally invasive TKA group had significant decrease in post-operative pain, hospital stay, and blood loss. The study showed that the mini-incision technique offered many benefits.
In another study comparing the two procedures, researchers compared 50 total knee arthroplasties performed with the traditional method with 50 that were performed using the mini-incision technique. The found that overall, the minimally invasive surgery took significantly longer to perform. The traditional approach was found to be easier for the surgeon, and a substantial learning curve may be required for the surgeon to perform minimally invasive knee replacement.
With traditional knee replacement, an incision of 6-8 inches is required. The patient’s size and the extent of joint damage will also determine the length of an incision. The doctor must have a large incision to fully visualize the joint, the implants, and the disease tissue.
With the minimally invasive technique, the incision is only 4 inches long, which is half the length of a traditional TKA incision. Surgeons perform surgery using special instruments that are designed to move around muscle and soft tissue rather than cut through it. A smaller incision is more aesthetically pleasing to the patient.
Recovery after total knee replacement from traditional techniques takes around 6-8 weeks, depending on age, health status, and previous knee injury. Each person’s recovery time will vary, but most patients drive after 3 weeks, garden after 4-6 weeks, and golf after 8 weeks. The surgeon will determine what activities you can participate in and which ones you must avoid.
After a minimally invasive knee replacement, recovery takes half as long than traditional surgery. While every patient is different, most people are driving after 2 weeks, gardening after 4 weeks, and golfing after 6 weeks. Regardless of which procedure you have, certain high-impact activities are not permitted, as they place extreme pressure on the new knee joint.
The minimally invasive approach is may not be an option for an overweight or obese person, as well as for very muscular people, those who require a complex replacement, and people with severe knee deformity or instability. The mini-incision procedure requires specialized instruments and is more technically challenging to the surgeon. According to some studies, the risks of complications is higher with the minimally invasive TKA, which can be detrimental for the final outcome of surgery.
While the minimally invasive total knee replacement is a good alternative in the hands of an experienced orthopedic surgeon, you should work with your surgeon to decide which procedure is best for you. Choose an Arizona total knee replacement surgeon who is experienced if you wish to have the mini-incision procedure, and work with your doctor to lose weight before surgery.
Minimally invasive surgery has gained popularity over the past several years. Early results have shown better functional outcome with early recovery and rapid rehabilitation.
Evaluation of the short-term clinical and functional outcome of minimally invasive surgery total knee arthroplasty (MIS-TKA) compared with the traditional total knee arthroplasty (TKA).
Materials and Methods:
During 2009, all cases scheduled for primary TKA through the modified mini-mid-vastus approach (MIS group) were studied. This group included 40 knees and was compared to a cohort control group of similar number of patients (40 knees) that underwent the procedure through the standard conventional technique (standard group).
Patients in the MIS group showed significant decrease in postoperative pain, blood loss in first 24 hours, and in hospital stay. Furthermore, they achieved motion considerably faster than the standard group with earlier return of quadriceps function and greater early flexion.
This study proved that MIS-TPA has the ability to couple the benefits of less invasive surgical approach.
Dabboussi N, Sakr M, Girard J, & Fakih R. (2012). Minimally Invasive Total Knee Arthroplasty: A Comparative Study to the Standard Approach. N Am J Med Sci, 4(2), 81-85.
King J, Stamper DL, Schaad DC, & Leopold SS (2007). Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty. Assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am, 89(7), 1497-1503.