Minimally Invasive Knee Replacement Surgery
Traditionally, knee replacement surgery makes use of a long vertical incision in the center of the knee to gain joint access. This method is highly invasive. The minimally invasive total knee replacement is a variation of the traditional approach. Here, the surgeon uses an incision that is smaller and cuts fewer tendons and ligaments. Endoscopic tools are used to visualize the surgical frame. Read More
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Minimally Invasive Knee Replacement Surgery
Knee arthroplasty or Total knee replacement is an orthopedic procedure usually performed to replace damaged or worn surfaces of the knee. The affected areas are replaced with implants or prostheses, thus increasing mobility and relieving joint pain and discomfort.
Damaged soft tissues, cartilage, and bone from the surface of the knee are removed in any knee arthroplasty. This surgery aims at providing maximum relief to the patient. Over the years, different techniques have been used to achieve this aim.
Knee replacement surgery
Traditionally, knee replacement surgery makes use of a long vertical incision in the center of the knee to gain joint access. This method is highly invasive.
The minimally invasive total knee replacement is a variation of the traditional approach. Here, the surgeon uses an incision that is smaller and cuts fewer tendons and ligaments. Endoscopic tools are used to visualize the surgical frame.
Indications for a minimally invasive knee replacement surgery
Significant knee injuries and medical conditions that affect the knee usually require a knee arthroplasty. They include but are not limited to:
- Osteoarthritis: This is the most common reason for a knee arthroplasty
- Rheumatoid arthritis
- Injury or fracture of the knee joint
- Bone tumor in the knee joint
Contraindications for a minimally invasive knee replacement surgery
Despite its advantages, there are limitations to the use of minimally invasive knee arthroplasty. They are:
- The complexity of deformity: Patients with severe knee injuries or deformities that require complex replacement are not good candidates for minimally invasive surgery.
- Body size: This procedure may not be appropriate for very muscular or heavy-set individuals. People who need a more complicated replacement or those with severe knee instability or deformity.
- Risk of complications: Due to its technicalities in an inexperienced surgeon, a minimally invasive knee arthroplasty has a higher risk of complication as opposed to the traditional approach.
- Health status: Patients with underlying conditions that would affect the wound healing process are usually not suitable for the minimally invasive procedure.
Types of a minimally invasive knee arthroplasty
Minimally-Invasive Quadriceps-Sparing Total Knee Replacement
This technique employs an incision of about 4 inches in length. It was first reported in 2003. The avoidance of the quadriceps muscle and tendon is the most important feature and allows for lesser pain and quicker restoration of joint mobility.
Minimally-invasive partial knee replacement (unicompartmental knee)
Patients who are 40 years of age and older with osteoarthritis limited to one compartment of the knee may be suitable for this procedure. Unlike the total knee replacement only the affected compartment is operated on, thus reducing the risks of postoperative complications.
The mini-medial parapatellar
This is a modification of a standard traditional knee replacement approach. This procedure put forward by Tenholder makes use of the standard medial parapatellar approach and arthrotomy but skin and quadriceps tendon incision are more limited, and the medial parapatellar arthrotomy is lesser. It requires less training than the other minimally invasive procedures but yields the same results as the quadriceps-sparing technique.
This approach was first reported in 2004 and is the most popular of the minimally invasive techniques. The patella is subluxed but not everted, and the vastus medialis is divided by just 2 cm. From the superomedial pole of the patella to just below the joint line, the skin is incised. This procedure could result in hematoma formation, vascular disruption, and denervation of a portion of the vastus medialis. These can be prevented if the division is kept to 2 cm or less.
In this approach, there is no quadriceps incision. The muscle is raised across the anterior aspect of the femur and retracted laterally. The incision is made distally along the medial side of the patella before continuing along the inferior border of the vastus medialis. It is difficult to perform in patients with large quadriceps mass to avoid damage to the quadriceps mechanism.
Preoperative preparation involves the physical examination of the patient and lab work. These help to ascertain patient suitability for the procedure.
One small incision of three to four inches long is used to accomplish the minimally invasive replacement operation. The artificial implants and prostheses used are the same as those used for traditional knee replacement. However, to correctly prepare the femur and tibia and install the implants, certain surgical devices are necessary due to the smaller incision size.
Following anesthesia (general or spinal), the surgical procedure is performed in aseptic conditions using a suitable minimally invasive approach.
Physical rehabilitation is a critical component of recovery thus therapy is instituted to aid in faster recovery.
- Blood clots and hemorrhage: Formation of blood clots or DVT (Deep Vein Thrombosis) and operative or postoperative bleeding is a dangerous side effect of knee arthroplasty. The use of blood thinning agents may be used before and after the surgery is carried out to prevent DVT while minimally invasive surgeries help to reduce the chances of hemorrhages.
- Infection: Infections may occur if the surgery was done in septic conditions. It might also be the result of difficulties brought on by post-surgical care. Antibiotics may be used in mild infections whereas severe infections may result in revision surgery.
- Fracture and dislocation: It is necessary to follow strict postoperative measures as fractures and dislocations can occur after surgery. Further stabilization of the limb may be required.
- Change in leg length: Muscle contractions subsequent to knee replacement surgeries may lead to a discrepancy in the limb length. Certain precautions can be taken to avoid this condition both intraoperatively and postoperatively.
- Loosening: The loosening of the prosthesis is rare but can occur due to wearing out, improper placement, or other causes.
- Nerve damage: Damage to the nerves can occur during or after surgery, despite being a rare consequence. Signs of nerve damage may include numbness, weakness, and pain in the affected limb.
Minimally invasive knee replacement is still an evolving technique, and more research is needed to fully understand and improve the long-term function and durability of the procedure. Fewer soft tissues are reportedly harmed with minimally invasive knee replacement, resulting in a shorter, less painful recovery and a quicker return to regular activities. Documented evidence suggests that the long-term benefits of the procedure are the same as those of a traditional knee replacement approach.