Minimally invasive knee replacement
In knee replacement surgery, the degenerated joint surfaces of the end of the thighbone (femur), the top of the shinbone (tibia), and the undersurface of the kneecap (patella) are surgically removed and replaced with artificial joint surfaces made of special metals and plastic. This operation is performed roughly 600,000 times a year in the US (we have a lot of practice at it!) and provides pain relief that patients are happy with about 90% of the time. Traditionally, the procedure was quite painful and the recovery period prolonged, but, fortunately, there have been significant advances in surgical techniques recently which have helped, including minimally invasive surgical approaches. Though there are several variations of the technique, the idea is to create less soft tissue damage than before while still ensuring that the artificial joint is properly positioned and secured. Through mini-parapatellar and subvastus techniques, we currently use a 4- to 6-inch incision in the front of the knee to do the surgery, instead of the traditional 8- to 10-inch incision. The smaller incision and minimized soft tissue trauma have made the procedure less painful to undergo and have shortened the stay in the hospital from 3 or more days to 2 days for most patients. Additional improvements have been made in pain management with ‘pre-emptive analgesia’ (giving pain medicine proactively before the surgery), ‘multimodal analgesia’ (using pain medicines from different classes of medicines), and using regional anesthetic techniques, such as spinal anesthetic and/or nerve blocks. The combination of advances has made the road to recovery shorter and smoother for most patients while still giving the excellent, predictable, long-term results we’ve come to expect.