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No pain, all gain

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Posted: Mar 19, 2008 at 2327 hrs IST

Total hip and knee joint replacement has become one of the most frequently performed and successful reconstructive procedures in orthopaedic surgery since its introduction a few decades back. As outcomes following joint replacement continue to improve, the demand for less traumatic and invasive surgery has increased, shifting the challenge towards less invasive, yet equally effective techniques that reduce pain and lead to a quicker recovery.

Potential Advantages of MIS
* Less blood loss
* Less trauma to the surrounding tissues
* Shorter hospital stays
* Generally earlier rehabilitation

But MIS is not suitable for everyone. Successful candidates for this type of surgery are generally at a healthy weight, in good health, younger than traditional joint replacement patients and must be motivated to work at their recovery.

Minimally Invasive Hip Replacement
Minimally invasive hip replacement surgery was created to allow surgeons to replace the hip through one or two smaller incisions. When the surgical incisions are smaller, fewer muscles and tendons are traumatized, which helps in quicker recovery for the patient. It also means less blood loss. A single minimally invasive hip incision may measure only three to five inches, depending on the size of the patient and the difficulty of the procedure whereas a conventional hip replacement would require a 10-12 inches cut. This incision is usually placed over the outside of the thigh. Muscles and tendons are split or detached to a lesser extent than in the traditional hip replacement operation.
The minimally invasive procedure involves implantation of cement less acetabular and femoral components and the focus is to make orthopaedic surgery a less traumatic experience. The patients gain by reduced blood loss, less pain, faster return to full activity, shorter hospital stay and reduced scar tissue.
Individuals who are obese or who have had previous hip or knee surgery are generally not suitable candidates. The decision to have this type of surgery must be made after a careful evaluation by the surgeons, and a discussion of the risks and benefits of MIS compared to traditional joint replacement.

Minimally Invasive Total Knee Replacement
Minimally invasive total knee replacement is a technique developed to minimize the negative effect on the quadriceps muscle (the muscle that runs across the front of your thigh). When you straighten out your knee while you are sitting, you feel this powerful muscle working. The centre of the quadriceps muscle is the quadriceps tendon, which provides much of the power to the knee joint. In traditional knee replacement surgery, this muscle and tendon group is usually split lengthwise to gain access to the knee. It is sewn and repaired at the end of the surgery. In minimally invasive knee replacement surgery, the knee joint is accessed without cutting through the quadriceps tendon. Patients have found they experience less pain and a quicker recovery with this type of surgery.
MIS should not be confused with arthroscopic procedures that treat torn cartilage and require only very small incisions. In MIS procedures, surgeons still must make an incision large enough to insert the knee implant - usually four to five inches long. Compared to traditional surgery it not only provides good cosmesis but also a faster recovery with less pain and shorter hospital stay.

The writer is senior consultant ortho & adult joint reconstructive surgeon

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