TYPICAL REPLACEMENT VERSUS MINIMALLY INVASIVE SURGERY
gg Total knee arthroplasty is a long procedure requiring much soft tissue trauma as well as exposing the entire joint as well as the tibia and femur. However, MIS or minimally invasive surgery holds the promise of reducing the chance of infection, operation time and length of stay in the hospital, perhaps changing the operation to an outpatient one.
Orthopedic surgeons at Rush University Medical Center found that 96 percent of patients who had minimally invasive total knee replacement surgery were able to go home the same day, without complications-many walking out unassisted or with a cane. Dr. Richard A. Berger pioneered and perfected minimally invasive outpatient surgery in 2003. He says that minimally invasive surgery is, “a comprehensive management approach that helps the patient avoid an overnight stay. It’s optimal sequencing and timing of interventions by the nursing, physical therapy, anesthesia surgical team; it’s a team approach of equally weighted preoperative, intraoperative, and postoperative care.”
The MIS Quad-Sparing total knee procedure is performed through one small three to four inch incision instead of a large, eight to 12 inch incision. This approach has the potential for dramatically reducing pain by sparing muscles and tendons that are usually cut during standard total knee arthroplasty (TKA) surgery. The operation does not require cutting the quadriceps muscle and quadriceps tendons as sometimes done in current TKA. Because there is less cutting of muscle and less blood loss, less anesthesia is required and the recovery time is greatly reduced. The patient can be out of surgery in less than two hours.
After surgery, patients see an occupational and physical therapist. Patients must be able to independently get in and out of bed, rise from a chair, walk 100 feet, and walk up and down a full flight of stairs before they can leave the hospital. If the patient feels comfortable and would like to go home, they are released with pain medication. Patients receive home physical therapy until they can drive. Then, outpatient physical therapy is started. Patients are evaluated clinically at one week, two weeks, six weeks, and three months [9]. Minimally invasive surgery in total knee arthroplasty is technically challenging and instrument dependent. The design of cutting guides, sizers, and retractors must continue to change and imrpove to further facilitate the viability of and make MIS ubiquitous, a new standard of treatment [10].
A minimally invasive total knee arthroplasty [14]
