Minimal Incision Total Knee Arthroplasty: Early Experience

Abstract

Total knee arthroplasty (TKA) has evolved during the past 30 years to a well-defined technical surgery with excellent results for as many as 20 years of followup. The concepts of exposure, ligament balancing, and joint alignment have been established clearly by Insall and others. In the early 1990s, Repicci introduced minimally invasive surgery for unicondylar knee arthroplasty. This approach suggested that less invasive surgery could accomplish similar results to those of standard unicondylar knee arthroplasty. Early reports in the literature support these conclusions. It only was logical that the minimally invasive surgery approach eventually would be applied to TKA. It is extremely important to establish a clear definition of the minimally invasive surgery and, then, to follow the results. We have completed 70 minimally-invasive TKAs during the past 9 months with early results that indicate less intraoperative blood loss, shorter length of stay, increased range of motion (ROM), with similar implant accuracy to standard TKA. These new procedures will require thorough evaluation as with any new clinical endeavor. It also is of paramount importance to remember that the main goal of any new technology is to advance the science of medicine without compromising the ultimate result for the patient. The early findings are encouraging for the future of minimally invasive TKA and we hope to improve the technology during the next few years.

Patellar Tracking and Anterior Knee Pain are Similar After Medial Parapatellar and Midvastus Approaches in Minimally Invasive TKA

“…The extensor mechanism suffers less damage and the patella is not everted in a MIS TKA, which would result in good patellar tracking and lower incidence of anterior knee pain. However, the literature shows only early recovery and less postoperative pain in patients who have had MIS TKAs [4,14,28], but does clarify the incidence of patellar maltracking or the development of anterior knee pain. Additionally, it is unclear whether the incidence of patellar maltracking or anterior knee pain differ with the MPP or MV approach in MIS TKAs.…”

“…It was believed to reduce hospitalization time [4,28], increase ROM [14,28], reduce pain [4,14], and more rapidly restore function [4]. In addition, if the quadriceps in the MPP approach is cut no more than 2 cm above the superior pole of the patella, the quadriceps recovers more rapidly [6,27].…”

Safety of, and biological and functional response to, a novel metallic implant for the management of focal full‐thickness cartilage defects: Preliminary assessment in an animal model out to 1 year

“…It offers the advantages of reduced intraoperative blood loss and pain, shorter hospital stay, and increased range of motion over more traditional arthroplasties. 23,24 Low-profile devices like the HemiCAP TM also preserve bone stock, allowing for subsequent modification. Unlike existing marketed devices, the HemiCAP TM also does not require replacement of the apposing tibial articular surface.…”

Avaliação isocinética em pacientes submetidos à artroplastia total de joelho

“…Some authors such as Tria and Coon 15 and Berger et al 12 have demonstrated the benefits of minimally invasive surgery in knee arthroplasty, such as smaller surgical incision, shorter hospitalization time, less postoperative pain and earlier ambulation without requiring orthosis. Still concerning the preservation of extensor apparatus in knee arthroplasty, Silva et al 24 say that a stronger quadriceps strength is associated to better scores in functional assessments.…”