There are many different definitions that have been used about minimally invasive surgery and total knee replacement. The reality is that there are several different ways to define this. Most surgeons agree that the length of the skin incision is the least important factor when looking at less invasive surgery.
Surgical techniques have evolved over the last five to ten years. We now use smaller incisions but by no means are these minimally invasive types of procedures. Total knees today still require an anesthetic to perform the operation, intramedullary alignment guides (i.e. rods that go inside the bone), the cuts are the same, and the implants are the same. But what has changed is the amount of soft tissue dissection that is involved in performing the knee replacement. In addition, we have modernized and updated our pain management protocols and structured our rehabilitation and patient eduction. Taking all of these factors together, patients can now recover more quickly with better early function and return to work. The keys to success in knee replacement are obtaining proper overall alignment of the limb, proper soft tissue balancing of the joint, and proper placement of the implants.
We utilize the smallest possible incision but make it large enough to get the job done properly. This balancing of exposure and newer modified cutting guides allow us to do the operation safely through a less invasive type of approach. Minimally invasive surgery should be more properly termed less invasive surgical exposure. Unlike arthroscopy or laparoscopy where we have converted previously open procedures to a more or less closed procedure, knee replacement and hip replacement still requires an open procedure and insertion of the implants.
Discuss the type of exposure, the pain management, and the type of program with your surgeon to get a better understanding of what is involved in the recovery process.
William P. Barrett, M.D.