Published online Nov 18, 2015. doi: 10.5312/wjo.v6.i10.804
Peer-review started: March 2, 2015
First decision: May 13, 2015
Revised: June 3, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: November 18, 2015
Minimally invasive surgery (MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty (UKA). Partial knee replacements were designed in the 1970s and were amenable to a more limited exposure. In the 1990s Repicci popularized the MIS for UKA. Surgeons began to apply his concepts to total knee arthroplasty. Four MIS surgical techniques were developed: quadriceps sparing, mini-mid vastus, mini-subvastus, and mini-medial parapatellar. The quadriceps sparing technique is the most limited one and is also the most difficult. However, it is the least invasive and allows rapid recovery. The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended. The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient. The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques. The surgeries are easier with smaller instruments but can be performed with standard ones. The techniques are accurate and do lead to a more rapid recovery, with less pain, less blood loss, and greater motion if they are appropriately performed.
Core tip: Minimally invasive surgery for knee arthroplasty began in the 1990s and flourished in the year 2000 to 2005. Four primary techniques were developed along with some instrument changes and modifications in the postoperative treatment protocols. The surgery is demanding and it is more difficult to develop the exposure. However, there is less pain, less blood loss, greater range of motion, with a faster, shorter recovery time.