Minimally invasive total knee replacement: principles and technique. Orthop Clin N Am

Department of Orthopedics, University of Utah, 2380 N 400 E, Suite G, North Logan, UT 84341, USA.
Orthopedic Clinics of North America (Impact Factor: 1.25). 05/2004; 35(2):235-45. DOI: 10.1016/S0030-5898(03)00113-5
Source: PubMed


Recent attention toward minimally invasive approaches to joint replacement has resulted in new MIS TKA techniques for the implant of conventional TKA implant components. These proposed techniques must be evaluated thoroughly and changes approached with caution. Medial and lateral techniques that minimize interruption and dissection of neuro-vascular tissues, muscles, tendons, and ligament shave been described. Patients who have undergone these procedures have benefited short term from quicker recovery time and less pain and have benefited long term from the use of conventional prosthesis. Before MIS can become an accepted surgical technique for TKA, a clear understanding of the unique guiding principles behind MIS TKA must be understood and realized. Once these basic principles are followed and the surgeon is familiar with MIS TKA techniques, this technique should prove to be a substantial step forward in the continuum of TKA procedure development.

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    • "MIS is defined as a type of surgery which requires a cutaneous incision of less than 10 centimeters, does not damage the quadriceps, does not avert the extensor apparatus, features no femorotibial luxation, and allows for the implantation of a standard arthroplasty [1] [2]. The goal is to reduce blood loss, cause a smaller cutaneous scar and less aggression to soft tissue, reduce postoperative pain and thus shorten hospital stay [3] [4] [5] while at the same time favoring a greater and faster recovery of mobility. There are still unanswered questions regarding the outcomes of the TKA-MIS technique, most notably whether it is a reproducible and cost-effective technique. "
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    ABSTRACT: The Minimal Invasive Surgery (MIS) technique used for knee arthroplasty implantation implies a less aggressive sur-gery and reduces the aesthetic impact. Its most notable disadvantage is the poor visualization of bone structures, which may lead to alterations in the correct placement of the prosthetic components. Navigation-assisted surgery may help avoid such mistakes, and thus navigation coupled with the MIS technique may be an alternative for the future. This is a prospective randomized study of 50 patients who received a total knee arthroplasty. In 25 cases the MIS technique was used, whereas in the other 25 navigation was also employed. Mean age of the patients was 71.63 years, and the mean body mass index was 31.19. Results were assessed based on the definitive radiographic position of the femoral, tibial, and limb axis prosthetic components, as well as according to the Visual Analogue Scale (VAS), the Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form version 12 (SF-12) ques-tionnaires, and the "up-and-go" test. Differences were found between both groups for duration of the procedure (p = 0.0005). No differences were found in the need for analgesics, amount of drained blood, or mean stay time. There were differences regarding the best radiographic position of the tibial component in the navigation group, but not in the final mechanical axis of the limb, even though out-of-range cases were more abundant in the standard-MIS group. At one year after surgery, clinical, functional and quality of life outcomes were similar in both groups. The combined use of surgical navigation and the MIS technique does not yield advantages in terms of limb alignment nor clinical results at one year after surgery.
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    • "This exposure involves patella eversion and generally is done through large incisions of approximately 20 to 30 cm. Although the long-term results of knee arthroplasty have proven to be excellent, the rehabilitation period often is long and painful [1]. In order to improve the patient's well-being in the immediate postoperative period and to lessen the aesthetic impact, other, less traumatic exposures (MIS-TKA) have been introduced, including the subvastus, midvastus, and lateral arthrotomy. "
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    ABSTRACT: Minimal invasion surgery (MIS) is a recent technique recommended for Total knee arthroplasty (TKA) but demands an effort of the surgeons and the learning curve may be long. Twenty six MIS-TKA were matched to 36 standard TKA with respect to age, sex, body mass index or preoperative score. All patients suffered from knee osteoarthritis, which had not improved with medical treatment and which presented a less than 10 degrees deformity in the coronal and sagittal radiographic projections. At six months after the surgery a specific questionnaire was completed as well as the KSS (Knee Society rating scale), the generic short-form health questionnaire (SF-12) and a visual analogue scale (VAS). The MIS technique required more time of surgery (p < 0.001), hospital stay was noticeably shorter (p < 0.05) and drainage volume collected after surgery was significantly higher in the standard technique. We observe a higher frequency in small sizes implants for MIS surgery but no statistically significant differences were found between both groups regarding the radiological alignment of the implant. At six months no differences were found between the groups in range of motion, KSS scores, the physical or mental subscale SF-12, patient's pain perception, satisfaction or subjective improvement. Minimal invasion surgery in total knee arthroplasty showed no improvement over a standard approach.
    BMC Musculoskeletal Disorders 02/2010; 11(1):27. DOI:10.1186/1471-2474-11-27 · 1.72 Impact Factor
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    ABSTRACT: L’applicazione della chirurgia mini-invasiva (MIS) alla protesi totale di ginocchio costituisce una tendenza non eludibile nel momento in cui la opportunità di conservare quanto più possibile le strutture anatomiche, ampiamente accettata concettualmente, si stia affermando anche nel riscontro clinico.
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