Minimally Invasive Knee Surgery
Hip and knee replacement are among the most common and successful orthopaedic surgeries. The indications for these surgeries are well established and their overall success documented by extensive research. Substantial pain relief and improvement in function is expected for most patients for 15 years or more after surgery.
Minimally invasive and small incision hip and knee replacement surgery is merely a variation of traditional joint replacement surgery encompassing an array of modifications to the original technique.
Less invasive or minimally invasive surgery involves a smaller incision than the traditional techniques. However, there is a misconception that the length of the incision is the key determinant of the quality of the result and the speed of the postoperative recovery. In reality the speed of postoperative recovery depends very little upon the length of the incision, but rather is determined by multiple factors including the extent of the arthritis being treated, the quality of the surgical technique, and postoperative pain management and rehabilitation protocols. Perhaps one of the most important features of our knee and hip replacement program involve optimized pain management protocols for rapid recovery, independent of the surgical approach used.
Techniques include “medial parapatellar,” “quad sparing,” “subvastus,” “mid-vastus” or “mini parapatellar” approaches. All of these approaches seek to minimize trauma to the extensor mechanism (quadriceps) and also all other anatomic structures around the knee. None of these approaches involve cutting across the quadriceps tendon. Clinical studies show that the outcomes of all of these techniques, when properly performed, are excellent with no significant differences in rates of recovery between any of these different approaches.
In minimally invasive hip replacement surgery, the incisions used are smaller than in years past. While minimally invasive techniques are utilized by all surgeons at the Rothman Orthopaedic Institute, it is important to realize that there is some trauma to the tissues in all cases. Most clinical studies that compare anterior, lateral, and posterior approaches show no significant differences and surgeons will select the surgical approach that works best for their patients.
Less invasive surgery includes unique pre- and post-operative pathways for anesthesia, nursing care and rehabilitation. These have facilitated the early discharge protocols that get our patients home soon after surgery. While some patients are hospitalized for 2-3 days, many now are discharged one day after surgery and some can go home on the day of surgery, if desired.
What to discuss with your surgeon
You should have a clear understanding of the goals of your joint replacement surgery before you proceed. A discussion of joint replacement surgery should include a review of the technique that your surgeon suggests. If your surgeon offers minimally invasive or small incision surgery, ask about potential short-and long-term risks and benefits of this type of surgery. Review his or her specific results for contemporary and minimally invasive surgery in relation to fracture, infection, blood clot, nerve injury and dislocation rates. Complications appear to be more common when the surgeon has less experience with this type of surgery. Inquire about his or her qualifications, competence and proficiency with the technique. Understanding the usual post-operative course, including hospitalization, blood loss, rehabilitation and return to work is important.