Outpatient Total Knee Arthroplasty With a Minimally Invasive Technique
Department of Orthopaedic Surgery, Rush Medical College, Rush-Presbyterian-St Luke's Medical Center, Chicago, Illinois 60612, USA. The Journal of Arthroplasty
(Impact Factor: 2.67).
11/2005; 20(7 Suppl 3):33-8. DOI: 10.1016/j.arth.2005.05.021
Fifty consecutive patients were enrolled in this prospective study. This was 37% of the 135 patients undergoing primary total knee arthroplasty (TKA) by one surgeon. The average patient age was 68 years (50-79 years). A comprehensive perioperative management pathway was developed and was implemented, which combined regional anesthesia with a minimally invasive, TKA technique in which the only incision in the capsule and extensor mechanism is a capsular incision from the joint line to the superior pole of the patella. Postoperatively, patients received oral analgesia. After specific discharge criteria were met, 48 patients (96%) chose to go home the day of surgery. No intraoperative complications occurred. There were 3 readmissions, none related to early discharge: gastrointestinal bleed at 8 days, superficial irrigation and debridement at 21 days, and a closed manipulation at 9 weeks. This study demonstrates that, in these selected patients, outpatient TKA was safe with no short-term readmission or complications related to early discharge. This comprehensive pathway may make it possible for this minimally invasive TKA to be done as an outpatient in specialized surgicenters in the future.
Available from: Angela Notarnicola
- "In 2005, Berger et al14 (Table 3) wrote about 50 patients who were enrolled in a prospective study. Patients aged between 50 and 80 years undergoing primary TKA without a history of prior open knee surgery qualified for enrollment. "
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ABSTRACT: Total knee arthroplasty (TKA) was a well-established procedure that had shown excellent long-term results in terms of reduced pain and increased mobility. Pain was one of the most important outcome measures that contributed to patient dissatisfaction after TKA. After a computerized search of the Medline and Embase databases, we considered articles from January 1st, 1997 to October 31st, 2009 that underlined the impact on patient pain perception of either standard open total knee arthroplasty or minimally invasive total knee arthroplasty. We included articles that used the visual analog scale (VAS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), Knee Score, Hospital for Special Surgery Score (HSS), Oxford Knee Score (OKS) as postoperative pain indicators, and we included studies with a minimum follow-up period of two months. We excluded studies that monitored only functional postoperative knee activities. It was shown that TKA with the open technique was a better treatment for knees with a positive effect on pain and function than the minimally invasive technique.
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ABSTRACT: Minimally invasive has been used to describe a wide spectrum of knee replacement procedures. This spectrum starts with a small
skin incision with a standard incision into the capsular and the quadriceps muscle and includes patellar eversion. The spectrum
currently ends with a small skin incision with a minimal capsular incision without quadriceps muscle violation and no patellar
eversion. This is currently called the quadriceps-sparing or capsular-only approach.
Whatever the definition used, minimally invasive knee replacement can be done and has been shown to be beneficial to patients
by minimizing surgical trauma, pain, and recovery.1–10 All of the varied minimally invasive techniques share common elements of reducing the trauma necessary for exposure, component
alignment, soft tissue balance, and component fixation. Ultimately, these benefits of minimally invasive knee replacement
result in a more satisfied patient.
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