As the number of people undergoing total knee replacements has grown, so has the number of surgical options available to patients. Approximately 70 to 80 percent of total knee replacements are performed using the traditional approach involving a larger incision that affords a surgeon a wide enough view to properly align the implant and bone. Precise alignment is key to the durability of the implant.
Other healthcare providers promote minimally invasive knee replacement using smaller incisions and less cutting of the tissue surrounding the knee. Advocates of this type of surgery say it allows for faster recovery, shorter hospital stays and less blood loss.
But aside from these potential short-term advantages, evidence suggests that minimally invasive surgery is no more beneficial than traditional total knee replacement in the long term. The minimally invasive approach is not for everyone. Further, risk of complications associated with a more complex operation may outweigh its benefits.
Comparing traditional to minimally invasive surgery
Traditional total knee replacement entails cutting into the quadriceps tendon, which connects the large quadriceps muscle group on the front of the thigh to the kneecap. The surgeon then moves the kneecap out of the way to access the arthritic joint.
Newer minimally invasive knee replacements spare the quadriceps tendon altogether. Instead, the surgeon marks through an incision in a muscle in the quadriceps.
Much of the power of your knee comes from the quadriceps. When this muscle and tendon group is cut out, as in traditional knee replacement, the repair and recovery may require a longer hospital stay and physical therapy.
Otherwise, there is no difference between minimally invasive and traditional knee replacement in terms of physical therapy, pain, walking speed and other measures of function during the recovery period.
Potential drawbacks to minimally invasive surgery
The minimally invasive approach may not be appropriate for heavy set or very muscular patients, those with severe knee instability or deformity, or those requiring a more complex replacement.
Other aspects to consider:
- Minimally invasive knee replacement is like repairing a car engine via the muffler rather than opening the hood — it might be possible, but it is more difficult. It requires specialized instruments and is more technically challenging because the surgeon has a smaller field of vision through which to do the operation.
- Medical literature shows that complications can be higher and the procedure may take longer, which is detrimental for the final outcome of the surgery. It also requires more training and has a significant learning curve. Anyone considering minimally invasive knee replacement should choose a surgeon who performs a high-volume of knee replacements.
- While the minimally invasive approach is a good alternative in the hands of an experienced surgeon, you should not limit your options to minimally invasive surgery if you have a good surgeon who performs the traditional approach.
What you can do
The first thing to do is get options from a surgeon who does minimally invasive total knee replacement and one who does only traditional surgery, and weigh the pros and cons of each.
After your decision:
- Choose only a surgeon who’s well experienced and performs a high volume for the type of procedure you choose.
- Work with your doctor to lose weight and lessen the strain placed on your knees.
- Stay as active as possible. Before your operation, have your physician recommend exercises that strengthen your quadriceps without causing pain. Good examples are riding a stationary bicycle and swimming or water therapy.
- Exhaust all conservation treatments (e.g., medications, injections and physical therapy) before considering knee replacement.
Carlos Higuera, MD, is an adult reconstruction orthopaedic surgeon who specializes in hip and knee replacements. He also has an interest in clinical outcomes research. He sees patients at Cleveland Clinic’s main campus. To schedule an appointment with Dr. Higuera or any of our surgeons, please call 440.312.6242.