Tria AJ, Scuderi GR. Minimally invasive knee arthroplasty: An overview. World J Orthop 2015; 6(10): 804-811 [PMID: 26601062 DOI: 10.5312/wjo.v6.i10.804]
Corresponding Author of This Article
Alfred J Tria, MD, Clinical Professor, Department of Orthopaedic Surgery, Rutgers-Robert Wood Johnson Medical School, the Orthopaedic Center of New Jersey, 1527 State Highway 27, Suite 1300, Somerset, NJ 08873, United States. atriajrmd@aol.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Nov 18, 2015; 6(10): 804-811 Published online Nov 18, 2015. doi: 10.5312/wjo.v6.i10.804
Minimally invasive knee arthroplasty: An overview
Alfred J Tria, Giles R Scuderi
Alfred J Tria, Department of Orthopaedic Surgery, Rutgers-Robert Wood Johnson Medical School, the Orthopaedic Center of New Jersey, Somerset, NJ 08873, United States
Alfred J Tria, Department of Orthopaedic Surgery, St. Peter’s University Hospital, New Brunswick, NJ 08873, United States
Giles R Scuderi, Orthopedic Service Line, Northshore LIJ Health System, New York, NY 10065, United States
Giles R Scuderi, Adult Knee Reconstruction, Lenox Hill Hospital, New York, NY 10065, United States
Author contributions: Tria AJ and Scuderi GR designed this research, performed the research and wrote the paper.
Conflict-of-interest statement: Dr. Tria receives royalties from Smith and Nephew Orthopaedics. He is a consultant for Smith and Nephew, Pacira, and Medtronic. He is an Editor for Elsevier. Dr. Scuderi receives royalties from Zimmer Orthopaedics. He is a consultant for Pacira and receives research support. He is a speaker for Convatec and Medtronic. He is an Editor for Elsevier.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alfred J Tria, MD, Clinical Professor, Department of Orthopaedic Surgery, Rutgers-Robert Wood Johnson Medical School, the Orthopaedic Center of New Jersey, 1527 State Highway 27, Suite 1300, Somerset, NJ 08873, United States. atriajrmd@aol.com
Telephone: +1-732-2494444 Fax: +1-609-4970655
Received: March 2, 2015 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
Abstract
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.
