Minimally invasive total knee replacement: principles and technique.
ABSTRACT 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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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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ABSTRACT: La teoría que ha motivado el desarrollo de las técnicas miniinvasivas en prótesis totales de rodilla (PTR) ha sido, como para las prótesis unicompartimentales, la disminución del traumatismo quirúrgico sobre los tejidos blandos y en especial sobre el aparato extensor, que permitiría una disminución de la estancia hospitalaria y una recuperación funcional más rápida, todo ello sin comprometer la posición de los implantes. Una vez que se indica la prótesis de deslizamiento, no existe contraindicación absoluta para el empleo de vías miniinvasivas. No obstante, no se aconsejan estas vías en las reintervenciones o en pacientes con un índice de masa corporal superior a 35 kg/m2. Tras realizar la vía de acceso cutánea, son posibles distintas opciones sobre el tendón cuadricipital y el vasto medial: la vía pararrotuliana interna, la vía midvastus o la vía subvastus. En todos los casos, el principio común a estas vías llamadas miniinvasivas es la subluxación lateral de la rótula sin su eversión. Es importante disponer de un instrumental adaptado a estas vías reducidas. Los resultados de las primeras evaluaciones clínicas parecen mostrar una recuperación funcional corta relacionada con una disminución de la agresión quirúrgica, sin comprometer la calidad de los componentes protésicos implantados.01/2009; 1(3):1–8. DOI:10.1016/S2211-033X(09)70099-4
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ABSTRACT: Purpose: Postoperative analgesia is vital for outpatient shoulder arthroscopy patients. Interscalene nerve block (ISB) is a well accepted method of shoulder surgery pain control but has reported disadvantages of significant complications and compromise of postoperative neurological evaluation. Continuous infusion local anesthetic pump (LAP) is a new technology for pain management. The purpose of this study is to compare ISB to LAP in patients having outpatient shoulder arthroscopy. Our hypothesis is that there is no difference between modalities. Methods: After a statistical power analysis, 55 consecutive patients, having outpatient arthroscopic shoulder surgery by a single surgeon were prospectively randomized to ISB or LAP. Included were patients having arthroscopic rotator cuff repair regardless of associated procedures. ISB was administered preoperatively, while subacromial LAP was placed intraoperatively and maintained for 48 hours. VAS pain scores were recorded twice daily for 2 days, then daily for 5 additional days. Quantity of Ibuprofen and Percocet use were also recorded as was total hospital costs (hospital charges multiplied by hospital cost to charges ratio) Results: No significant differences were found between groups with respect to pain at any time interval (p-value range 0.23 to 0.95), medication use (p-value range 0.55 to 0.98), or total hospital costs (p=0.72). There were no complications in the ISB group, while one LAP catheter was inadvertently removed at 24 hours. Conclusions: Our results demonstrate no differences between ISB and LAP. These results are clinically relevant because incidence of outpatient shoulder arthroscopy is increasing as are societal expectations with regard to surgical pain management. O-2 Influence of posterior capsular tightness on the pathogenesis of type II SLAP lesion in throwing shoulder injury Nakagawa S. Purpose: Though posterior capsular tightness was often seen in throwing shoulder, its pathologic significance has not been elucidated. Morgan, Burkhart, et al. reported that in throwing shoulder posterior capsular tightness with internal rotation deficit tended to develop type II SLAP lesion and predominantly injured posterior site of superior labrum by peal-back phenomenon (posterior subtype). They also reported that as accompanied rotator cuff tears were secondary lesion-location specific, they were often located posterior. In the present study, we investigated the influence of posterior capsular tightness on the pathogenesis of type II SLAP lesion in throwing shoulder injury. Materials and methods: Among 48 shoulders, those underwent arthroscopic surgery because of throwing injury between 2002 and 2004, 22 shoulders with type II SLAP lesion were included in this study. Regarding their subtype of type II SLAP lesion by Morgan´s classification, there were anterior subtype in 6, posterior subtype in 13, and combined subtype in 3. According to the presence of posterior capsular tightness, they were divided into 2 groups; tightness group in 12 and non-tightness group in 10. Posterior capsular tightness was defined as positive when the affected shoulder showed internal rotation deficit and stiffness and loss of elasticity of posterior band of posterior-inferior gleno-humeral ligament on arthroscopic finding. Incidence and subtype of SLAP lesion, and incidence and site of accompanied rotator cuff tear were investigated between these 2 groups.