Minimally Invasive Total Knee Arthroplasty
- Author: Derek F Amanatullah, MD, PhD; Chief Editor: Erik D Schraga, MD more...
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.
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
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
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. 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.
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.
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.
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.
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