Over the past 10 years, there has been a lot of discussion and advertising of “minimally” invasive knee replacements as an option for those with end-stage knee arthritis. Our last blog post talked about “minimally” invasive hip replacements and it’s pros and cons ( https://wordpress.com/stats/day/nwomedicine.wordpress.com ). We’d like to direct attention a little south (or distally in medical terms) of the hip to the knee.
With a lot of attention to advertising the minimally invasive procedures, one is likely to wonder how much is real and how much is just that, advertising and marketing. On paper, it sounds great so let’s review both the Pros and the Cons of this procedure.
First, what is a minimally invasive knee replacement? This type of surgical procedure uses smaller incisions and utilizes less cutting of the tissue surrounding the knee. Intuitively, this sounds good. Let’s compare and contrast the pluses and minuses of the traditional total knee replacement (TKR) with minimally invasive.
A traditional TKR requires an incision approximately 8-10″ in length vs. that of minimally invasive at 4-6″. Therefore, there is less damage to the skin and surrounding soft tissue, including muscles, ligaments and tendons. In the short term, it makes sense that there’s less immediate post-operative pain. There is less blood loss in surgery from the smaller incision and, of course, a smaller residual scar.
However, The Cleveland Clinic orthopedic surgeon, Carlos Higuera, MD, describes the minimally invasive procedure like this: “Minimally invasive knee replacement is like repairing a car engine via the muffler rather than opening the hood — it might be possible, but it is more difficult.” Visualization of the joint and surrounding muscle, tendon, nerves and blood vessels is more difficult and can lead to complications.
Medical literature shows that like the minimally invasive hip replacement, risk of complications can be higher and the procedure may take longer, which is detrimental for the final outcome of the surgery. Minimally invasive total knee replacement is not suitable for all patients. Your surgeon will conduct a thorough evaluation and consider several factors before determining if the procedure is an option for you.
Generally, candidates for minimal incision procedures must be thinner, younger, healthier and more motivated to participate in the rehabilitation process, compared with patients who undergo the traditional surgery. There are many limitations to qualify for this procedure to start.
Therefore, minimally invasive surgeries are less suitable for patients who are overweight or who have already undergone other knee surgeries.
An additional limitation is for patients who have a significant deformity of the knee (very knock-kneed or bowlegged), those who are very muscular, and those with health problems such as slow wound healing may be at a higher risk for problems from minimally invasive total knee replacement. Most surgeons advise against the procedure with the above limitations or complications.
Although minimally invasive total knee replacement sounds good, there are many limitations that are sometimes difficult to meet. Some potential complications may make traditional TKR a more attractive or even necessary option for those with severe knee osteoarthritis.
The discussion to this point has been on the surgical side of TKR. But, timely and quality physical therapy for rehabilitation is a big factor in achieving a positive outcome even given a good immediate replacement.
If you or someone you know is looking into procedures or therapy to address knee arthritis and are looking for experienced professionals, give us a call at: 419.427.1984 and check out our website at: http://www.nwomedicine.com