Minimally Invasive Knee Replacement (cont.)
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Minimally Invasive Knee Replacement Preparation
Being educated about what to expect is important after minimally invasive knee replacement surgery. Patients should have realistic goals for their recovery. Keep in mind that each person recovers differently. In fact, people who undergo knee replacements of both knees at once often experience somewhat different recoveries on each side.
The term minimally invasive is somewhat misleading and overused. It is still a surgery, and any surgery is invasive. The human response to injury includes discomfort, altered emotions, and a recovery period until healing occurs. Minimally invasive surgery can reduce, but not eliminate, these normal responses to the trauma of surgery. Minimally invasive surgery also does not mean risk-free surgery. Knee replacement surgery, regardless of technique, is associated with risk of infection, nerve injury, deep blood clots, premature implant loosening and failure, unexpected knee stiffness, continued pain, unpredictable medical complications, and even death. While these complications are uncommon, people undergoing knee replacement surgery need to be aware of them before undergoing any type of reconstructive procedure.
Usually, minimally invasive surgery simply means performing a big operation through a small incision. In other words, the deep muscle injury is often unchanged, but the scar is smaller. Surgeons who perform at least 100 knee replacement procedures per year are most able to progressively begin shortening the incision, while keeping the procedure the same. Many orthopedic implant companies have developed special instruments and training for surgeons. Learning more about the procedure by reviewing the patient educational materials provided on an orthopedic company's Web site, such as Zimmer, Inc., can be helpful. The Web site can help identify surgeons in the area who use a particular company's implants and are therefore qualified to perform the procedures safely.
Considerable difference exists between most knee replacement procedures that are performed by making a shorter incision and the so-called quadriceps-sparing knee replacement procedure.
Minimally Invasive Knee Replacement
The quadriceps muscle is actually a group of four well-developed muscles in front of the thigh that connect to the kneecap through a common tendon called the quadriceps tendon. This group of muscles controls movement of the knee and is critical for normal walking and standing. Traditional knee replacement surgery involves cutting into the quadriceps tendon to turn the kneecap over and push it out of the way in order to expose the arthritic joint that is to be replaced.
In minimally invasive surgery, a surgeon uses the same surgical technique as described above, except the cut in the quadriceps tendon is smaller. Instead of being turned over, the kneecap is pushed to the side. Special instruments allow the entire surgery to be performed through a smaller skin incision. The smaller cut to the quadriceps tendon considerably eases recovery. A patient who has had this type of surgery may be able to leave the hospital on the day of surgery or just a day or two later.
Well-trained surgeons using special instruments can shorten the incision of a standard knee replacement from 8-12 inches to about 4 inches. Incision size is ultimately dependent on each person's anatomy and body fat. Severe arthritis with deformity and heavier people require longer incisions to allow the replacement to be done safely. In most cases, a 4-inch scar is sufficient for the surgeon to enter the knee joint and to perform the procedure properly.
B Sonny Bal, MD
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