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Minimally Invasive Total Knee Arthroplasty

  • Author: Derek F Amanatullah, MD, PhD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Apr 30, 2015
 

Background

In addition to conventional surgical approaches, total knee arthroplasty (TKA) may be done by means of minimally invasive surgery (MIS). Minimally invasive TKA (MIS-TKA) is often portrayed in the lay community and press as involving a small skin incision. Actually, MIS-TKA is defined by limited soft tissue and bony dissection. MIS-TKA was developed after the description of unicondylar knee arthroplasty.[1, 2]

Conventional TKA is a successful operation for patients suffering from arthritis of the knee with a reported complication rate of less than 2% and an implant survivorship of 95% at 10 years. The aim of MIS-TKA is to decrease postoperative pain and shorten the rehabilitation period.

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Indications and Contraindications

MIS-TKA is used as an alternative to conventional TKA. However, there are conflicting data on whether MIS-TKA is an acceptable replacement for or even an improvement on conventional TKA, and no definitive answer to this question is available at present.

No absolute contraindications exist to MIS-TKA; this procedure is defined by limited soft tissue and bony dissection. Conventional TKA is probably a more suitable choice for the following patients[3, 4, 5] :

  • Patients with a body mass index (BMI) greater than 40 kg/m 2
  • Patients with severe fixed valgus deformity
  • Patients with severe osteoporosis
  • Patients who have previously undergone knee arthrotomy
  • Patients with rheumatoid arthritis
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Technical Considerations

Complication prevention measures recommended for MIS-TKA are exactly the same as those recommended for conventional TKA and should include the following:

  • Appropriate preoperative screening and clearance
  • Preoperative templating and planning
  • Preoperative administration of antibiotics as recommended by the American Academy of Orthopaedic Surgeons
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Outcomes

Early series comparing MIS-TKA with conventional TKA reported successful outcomes.[6, 7] In a retrospective review of 48 knees, MIS-TKA patients were able to complete an active straight leg raise earlier than conventional TKA patients could.[8] A case-control study comparing 32 knees after conventional TKA and after MIS-TKA reported mean Knee Society Scores (KSS) of 94 and 96 and mean functional scores of 90 and 99, respectively.[9]

A randomized, double-blinded trial that investigated extensor and flexor muscle function after conventional TKA and MIS-TKA found that the MIS-TKA group had a higher knee extensor peak torque at 3, 6, and 12 months postoperatively.[10]

Another prospective randomized trial, which compared conventional TKA with MIS-TKA by using an accelerometer, found that MIS-TKA patients were significantly more active on all postoperative days and that MIS-TKA patients achieved 80% of their preoperative acceleration in about half of the time that conventional TKA patients took to reach this level.[11]

A systematic review of 13 randomized controlled trials found that the mean KSS at 6 and 12 weeks postoperatively was higher in the MIS-TKA group but that this difference was lost at 6 months.[12]

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Contributor Information and Disclosures
Author

Derek F Amanatullah, MD, PhD Assistant Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine

Derek F Amanatullah, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Orthopaedic Research Society, American Association of Hip and Knee Surgeons, California Orthopedic Association, International Cartilage Repair Society

Disclosure: Received honoraria from Sanofi for message board participation; Received honoraria from Medscape for manuscript preparation; Received intellectual property rights from Dynamic Tension Plantar Fasciitis Splint for patent pending; Received intellectual property rights from Cool Cut Cast Saw Blade for patent pending.

Coauthor(s)

Paul E Di Cesare, MD 

Paul E Di Cesare, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References
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Midline skin incision is performed. Mini-incision is approximately twice length of patella, 6-14 cm (blue); conventional incision is longer (red extensions).
Parapatellar arthrotomy is performed (ie, median parapatellar, midvastus, subvastus, or lateral) to access knee joint and perform arthroplasty.
 
 
 
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