Two studies presented at the 21st Annual American Association of Hip and Knee Surgeons in Dallas, Texas in November of 2011 reviewed the effect of surgical exposure, in particular use of quad sparing versus conventional total knee arthroplasty. They checked multiple variables including postoperative pain, quality of life, quadriceps strength postoperatively, gait, and function. One of the studies by Dr. Pagnano at the Mayo Clinic, was a prospective, randomized study dividing patients equally into a quad sparing and conventional total knee group. Patients and the evaluators were blind to which technique was used in the patients. Using objective measures postoperatively, they found no difference in the two groups, specifically no difference in pain control, quadriceps strength, gait, or function. In a second study presented at the same meeting, similar results were found. The bulk of data available in the orthopedic literature would support the fact that the surgical approach by itself has no significant impact on the outcome of knee replacement. Rather improved outcomes over the last several years would be attributed to multimodal pain management, preoperative education, and aggressive physical therapy. All of these components, when utilized together, lead to more rapid rehabilitation and earlier return to activity.
Groups of surgeons have traveled around the west toting more precise joint replacement and better outcomes as a result of “less invasive techniques”. The orthopedic literature does not support those claims, and while many claims are made, the objective data does not back up what some of the surgeons advertise.
As a patient, you want to look for a program that has a comprehensive approach to joint replacement surgery, evaluates and documents it’s outcomes in objective forms, and can back up it’s claims made with objective data.
William P. Barrett, MD