Dr. Manju Wadhwa
A breakthrough in latest concepts in Knee Replacement Surgery combines benefits of minimally invasive surgery, patient specific implants with higher flexibility, modified pain control concepts and minimal bleeding even to suit our geriatric population
A new minimally invasive procedure may help individuals who face advanced osteoarthritis of the knee and hip continuing “Keeping pace with life”. As outcomes following joint replacement continue to improve, the demand for less traumatic and less invasive surgery has increased, shifting the challenge towards effective techniques that reduce pain and lead to a quicker recovery.
Knees wear out for a variety of reasons. These include inflammation from arthritis, injury or simple wear and tear. A knee replacement is the resurfacing of the worn out surfaces of the knee. A surgeon replaces lost cartilage with metal and plastic. This is typically done through an incision down the center of the knee.
In traditional knee replacement surgery, the surgeon makes a long incision over the middle of the knee and cuts muscles, tendons and ligaments to get to the knee joint. When more tissues, muscles and tendons are cut during surgery, the recovery is more painful and the healing process takes longer. The Tissue Preserving Total Knee Replacement surgery goes beyond the general scope of conventional TKR surgeries using smaller incision and special instruments to approach the knee from the front with minimal trauma to the soft tissue, muscles and tendons. In this technique even the knee cap does not have to be moved as far to get to the knee joint. The same types of joint prosthetics are used as the total knee replacement; however, it is more precisely and carefully placed through the muscle and tendons.
The specialized technique allows the advantage of satisfactory surgical exposure in all patients including the very obese with easy implantation of standard implants with specialized instrumentation. Patients expect a painless, functional stable knee as their first priority, but deep knee flexion is unquestionably next in line!
In minimally invasive knee replacement surgery (MIS), the knee joint is accessed without cutting through the quadriceps tendon called “quad-sparing”. Patients have found they experience less pain and a quicker recovery with this especially done with computer navigation.
The over all impact of tissue preserving TKR surgery is that there is less soft tissue sacrificed during operation. Post surgery pain is considerably reduced and substantially less bleeding. In most cases a single blood transfusion is required for both knees and almost no transfusion for a single knee. This technique allows faster rehabilitation, better muscle strength early return of knee motion. Most patients can walk on day 1 after surgery.
After surgery recovery time is less than one third of that with conventional TKR technique.
Improved Pain Control Concepts
Pain during and after joint replacement surgery is the biggest hindering factor for physical and emotional recovery of patients undergoing joint replacement surgery. If the pain can be controlled then not only can it be very comfortable for the patient but also it will lead to a much faster and quicker recovery. Now the ultimate concept in best centers globally is based on reduced tissue trauma surgery and pain control using cocktail of medicines to be injected in soft tissues around the knee during surgery making patients feel more comfortable post surgery. Most of these patients are even able to raise their legs a few hours after surgery.
New ways to open the knee may be more important than the length of the incision. These are sometimes called “quad-sparing” because they protect the quadriceps (the muscle on the front of the thigh) and make the recovery easier. Several early studies of MIS knee surgery have shown benefits such as less blood loss, shorter hospital stays, better motion, faster recovery and also better cosmesis.
Apart from MIS techniques also there is recently an increased demand in Asian population for patient specific implants high flexion implants giving higher flexibility and ability to sit cross legged or even in a few to squat post surgery. This also comes with additional durability for younger population where longevity of these artificial parts is a serious concern.
Now all patients who want to not only get back to an active lifestyle but also resume their leisure activities like light sports here’s an option quad sparing minimally invasive TKR: super performance in high flexion.
(The author is Director Head Max Elite Institute of Orthopedics & Joint Replacement)
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