Minimal invasive knee replacement surgery

It is not less than a marvel for people who undergo knee replacements to walk independently in just a few hours post-surgery. Thanks to the progress that knee replacement technology has made--we see a lot of people with a history of knee surgeries and replacement procedures run marathons and lead a higher quality of life.

Knee replacement surgery is one of the most successful modern orthopaedic procedures. However, pain and other side effects associated with the surgical procedure remain a concern for many people. In particular, people are concerned about the uncomfortable physical therapy that is often required after knee replacement surgery to regain muscle strength and mobility.

Minimally invasive knee replacement surgery on the other hand is commonly used to describe several modifications of conventional knee replacement surgeries. These modified procedures are designed to reduce the tissue trauma associated with surgery. The goal is to reduce post-operative discomfort, speed up recovery and discharge, and reduce the need for physical therapy.

Some advantages include:

Less damage to the skin and surrounding soft tissue, including muscles, ligaments and tendons

Less blood loss during surgery

Less post-operative pain

Smaller scar

Shorter hospital stay (2-4 days as compared to 5-7 days)

Difference between traditional replacement surgery and the new-age techniques

Traditional knee replacement surgery involves cutting into the quadriceps tendon to turn the kneecap over and push it out of the way to expose the arthritic joint that is to be replaced. Minimally invasive knee replacement is performed through a shorter incision—typically 4 to 6 inches, versus 8 to 10 inches for traditional knee replacement. A smaller incision is done by utilizing special instruments, allowing less tissue disturbance.

Traditional knee replacement is done through a cut in the quadriceps tendon, whereas the tendon is completely spared in minimally invasive knee replacement.

A Subvastus approach to the knee allows us to approach the same surgery by lifting up the muscles, rather than cutting through them. The patella is not everted but slid to the side during the procedure, enabling the surgeon to use a smaller incision.

This greatly reduces bleeding and postoperative pain. This has also significantly reduced the need for postoperative drains and catheters in patients undergoing knee replacements today.

New and improved anaesthesia techniques, as well as pain management medications and methods, have reduced pain & improved recovery after knee replacement surgery. Any method of speeding up recovery after surgery is desirable, as many people are anxious to return to their day-to-day activities.

Who is eligible?

Knee replacement surgery should be sought when a person has debilitating pain that is not responding to pain medications, exercise, weight loss, and reasonable activity modification. The best candidates for minimally invasive knee replacement surgery are:

Younger people (though opinions vary, this generally means patients younger than 65yrs)

Thin, not obese or overly muscular people

Small or medium frame people. Those who need larger sized implants seem to have more complications

Without bone and joint deformity, such as severe Osteoporosis, knock-knees or bow-legs

People who are motivated and well-informed about their surgery and rehabilitation

Patient education is critical to ensure the desired outcome of a minimally invasive knee replacement surgery. It is important to understand the available information and using that knowledge to become an active, and participating partner in planning the procedure. This will help you to be aware and realistic of the expectations, benefits, and limitations of knee replacement surgery – which are critical for successful outcomes after surgery. Every person recovers differently. Even two identical surgical procedures in the same person can be associated with a unique recovery. For example, patients who undergo two knee replacements at the same time, one on each knee, can experience somewhat different recoveries on each side.

(The writer is Consultant- Orthopaedic Surgery at a network of hospitals in Mumbai)