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Document Title: Bonutti-JBJS-Dec04.shtml
Article Title: Minimally Invasive Total Knee Arthroplasty
Authors: Peter M. Bonutti, MD, Michael A. Mont, MD, Margo McMahon, RN, Phillip S. Ragland, MD and Mark Kester, PhD
Publication: Journal of Bone and Joint Surgery
Date: December 2004
Volume 86, pages 26-32
Keywords: Total Knee Replacement, TKR/TKA, arthroscopy, bicompartmental osteoarthritis.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This article, complete with full-colour photographs of in-progress knee surgeries, shows in detail how a total knee prosthesis is installed with a minimum of incisions. (Note that TKR/TKA typically involves the removal of substantial amounts of bone and other structures in the knee, and thus qualifies as a drastic procedure by any standard. So, any modification to the procedure which makes it less drastic is especially desirable from the patient's viewpoint.) The authors describe a surgical technique (the lateral approach) aimed at making rehabilitation less painful for patients. By going through the iliotibial band, the procedure avoids invading the quadriceps (extension) musculature. Also, there is no need to dislocate the knee when removing the bone in preparation for prosthesis installation.
Introduction
Patient demand, potential health-care savings, and the development of new instrumentation and techniques have led to the rapid advancement of less invasive surgical approaches. Minimally invasive surgery is an evolutionary process that has transformed the surgical practices of surgeons not only in the area of orthopaedics but also in other medical fields. Currently, initiatives promoting minimally invasive surgery are under way for total hip arthroplasty as well as spine surgery, in an attempt to avoid highly invasive open procedures that result in slower rates of recovery for the patient.
The introduction of minimally invasive approaches for knee replacement has been driven partially by the application of small incisions and minimal soft-tissue approaches in the performance of unicompartmental knee arthroplasty1-3. While some surgeons have expressed concerns about minimally invasive surgery and its relevance to total knee arthroplasty as well as the safety of operations performed "through a keyhole," there are many reasons why we believe that this is an important endeavor, one that should direct the future of knee replacement surgery. The driving focus includes patients' concerns about the postoperative pain, prolonged rehabilitation, and lessthan-ideal functional outcomes associated with standard total knee arthroplasty. Minimally invasive total knee arthroplasty may be able to address these concerns.
We will describe the technique for minimally invasive total knee arthroplasty and the preliminary findings from three studies in which this technique was performed. A description of a quadriceps-sparing approach, along with its early results, also will be described.
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