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Minimally Invasive Total Knee Arthroplasty Periprocedural Care

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

Patient Education and Consent

It is imperative to ensure appropriate patient education before either conventional total knee arthroplasty (TKA) or minimally invasive TKA (MIS-TKA). Such education should address the patient’s postoperative expectations, as well as inform the patient regarding the administration of anticoagulation. Preoperative counseling with respect to the patient’s postoperative activity level is left to the discretion of the surgeon.


Preprocedural Planning

Preoperative evaluation and preparation for MIS-TKA are exactly the same as they would be for conventional TKA, except for the specialized surgical instrumentation and implants involved in the minimally invasive technique. Because exposure may be limited, many retractors are designed to protect the soft tissues during osteotomy. An example is a two-pronged retractor that serves to protect the collateral ligaments while the distal femoral cuts are made.

Special MIS-TKA instrumentation has been developed to facilitate either a medial or a lateral approach; left medial instruments can be used as right lateral instruments and vice versa.[13] Manufacturers have also developed smaller cutting blocks to facilitate access through a smaller surgical window. Ultimately, the size of the implant limits the size of the skin incision and the arthrotomy.

The tibial tray has been designed with a shortened or modular keel; this decreases the need for subluxation of the tibia and makes placement of the tibial tray easier at cementing. With cemented components, a meticulous effort must be made to remove excess cement with a limited exposure. The lateral femoral condyle and the lateral tibial plateau are common areas of residual cement that should be routinely explored.[14]



Starting in 1940, metallic implant materials were developed, and metal or ceramic prostheses have been part of knee reconstruction ever since. The term knee replacement was descriptive of some early attempts when hinge-type prostheses were used. Today, all contemporary prostheses just resurface the degraded joint surfaces, yet the procedure is still described as knee joint replacement.

All knee prostheses today utilize a polyethylene polymer for the tibial and often the patellar articulating surfaces. Metal-on-metal implants were used originally, but corrosion occurred in situ and limited their success. Polyethylene has been in constant use for more than 40 years for knee replacement surgery.

Knee prostheses can be secured to the underlying bone with either a porous metal surface or with the use of acrylic resins as an anchoring cement. Both methods are quite successful. Currently, more than 150 types of knee replacement implants, made by several manufacturers, are available.

Contributor Information and Disclosures

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.


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.

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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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