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Overview

Total knee replacement surgery is the procedure carried out for the patients suffering from severe pain or swelling in the knee joint. This pain or swelling, can be due to either arthritis or a fracture. Typically, in total knee replacement surgery, the surgeon cuts out the damaged cartilage, bones and some soft tissues. The artificial implant or prosthesis is then inserted into the bones. The aim of this surgery is to provide the patient with a pain free normal life that lasts for long. There are two approaches to carry out the surgery i.e. traditional open surgery and minimally invasive knee replacement surgery. In an open surgery, a long vertical cut is made on the front of the knee to clearly view and operate the joint. However, in minimal invasive surgery a smaller cut is made and a less invasive technique is used to reach and operate the joint.

 

What is Open Surgery?

In an open surgery, the long incision is made in front of the knee. The incision is typically 8- 10 inches long. Many muscles, tendons and soft tissues are cut in order to get a better view and approach to the damaged bones. The knee cap is turned by 180 degrees to get easy access to femur (thigh bone) and tibia (shin bone). The damaged cartilage and ends of femur and tibia are cut and the metal stems of the implant are inserted into the bones. A liner or spacer is added between the metal stems to allow easy movement. The undersurface of the knee cap is resurfaced with a plastic button, if required.

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What is Minimally Invasive Surgery?

In minimally invasive surgery, various techniques are used by the surgeon in order to cause lesser damage to the body compared to open surgery. As a result,minimally invasive surgeryhas lesser pain and shorter recovery period.

For minimally invasive knee replacement surgery, the surgical method is almost the same as the open surgery. However, lesser number of muscles, tendons and soft tissues are cut. An incision of around 4-6 inches is made in front part of the knee, which account for less tissue disturbance.

The implants used are same as that used for open surgery. However, special surgical instruments are used to prepare the bones and to place the implants at its place.

The techniques used to open the knee, also, are less invasive. The technique most commonly used is known as “quadriceps sparing”. This technique avoids trauma to the quadriceps muscles and tendons in the front of the thigh. Other techniques that can be used are midvastus and subvastus. All the above techniques are less invasive compared to the traditional open surgery.

As, the minimally invasive technique has smaller incision and causes lesser damage to the muscles; the healing time for the surgery wound is considerably reduced. The risk of infection after the surgery is also minimized. The post surgery pain is also reduced to a great extent.

Thus, minimally invasive knee replacement surgery, provide the patient quicker and more comfortable recovery.

Minimally Invasive Surgery v/s Traditional Open Surgery

  • The size of the incision in minimally invasive surgery (4-6 inches) is around half of the size of incision (8-10 inches) made in an open surgery.
  • For an open surgery, the tibia (shin bone) has to be dislocated from the femur (thigh bone) before inserting the implant. However, for minimally invasive technique no such dislocation is required.
  • During an open surgery the quadriceps muscles at the front of the thigh and some soft tissues are cut. Whereas in minimally invasive surgery, certain muscles are just shifted or pushed out of the way rather than cut. However, the incision may extend to some deeper soft tissues.
  • In an open surgery, the kneecap is turned over 180 degrees so as to give surgeon an easy access to the bones that form the knee joint. For minimally invasive surgery, the knee cap is just pushed out the way.
  • Bleeding during the surgery, for minimally invasive technique is lesser than for the traditional open surgery.
  • Surgery time for minimally invasive technique is generally greater than the time taken for an open surgery.

Conditions required for Minimally Invasive Surgery

Although minimally invasive technique has many benefits, it is not suitable for everyone. People, who are overweight or those who are very muscular, are not suitable for a minimally invasive knee replacement surgery. In addition, patients who have already gone through a knee surgery earlier or have a significant deformity of the knee are also not considered for minimally invasive technique. Typically people who are thinner, younger and more active are good candidates for a minimally invasive surgery.

  • Muscle relaxants: Useful in case of neck spasms.
  • Antidepressants: Can help in case of persistent pain
  • Steroid injection: A trigger point, facet. or Epidural steroid injection that is given directly on neck can help in severe pain.
  • Surgery: If the person is suffering from persistent pain, muscle weakness, loss of bladder functions etc, surgery might be the last resort.

Risks and Complication in Minimally Invasive Surgery

Minimally invasive surgery has smaller incision which results in reducing the risks compared to an open surgery. But, the risks like infection, wound healing problem, nerve injury and improper positioning of implants, still exists. Another risk with minimally invasive technique is that, if after making the small incision for this technique the surgeon is not able to do the replacement procedures properly, the surgeon may have to go for an open surgery. In such a case pain, recovery time and risk of infection increases considerably.

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