Minimally invasive total knee arthroplasty: a 10-feature evolutionary approach

Area of Science:

• Orthopedic surgery
• Arthroplasty
• Minimally Invasive Surgery

Background:

• Traditional total knee arthroplasty (TKA) involves extensive open exposure, prolonged patellar eversion, and tibiofemoral joint dislocation.
• Minimally invasive total knee arthroplasty (MIS-TKA) aims to reduce surgical trauma and improve patient outcomes.

Purpose of the Study:

• To advocate for an evolutionary rather than revolutionary approach to MIS-TKA.
• To detail the progression from open TKA to current MIS-TKA techniques.

Main Methods:

• Evolution of surgical exposure: from extensive open incision to VMO muscle split with patellar subluxation.
• Minimizing patellar eversion and avoiding gross tibiofemoral joint dislocation.
• Progressive downsizing of incisions and reduced damage to the quadriceps mechanism.

Main Results:

• Current MIS-TKA techniques, while demanding, offer significant patient benefits.
• The evolutionary approach reduces soft tissue damage compared to traditional methods.

Conclusions:

• An evolutionary, stepwise advancement in MIS-TKA is crucial for safe adoption.
• Future advancements may involve computer navigation for bone cuts and implantation, requiring new techniques and rigorous clinical evaluation.
• Surgeons must exercise caution to avoid revolutionary changes with existing implants to prevent catastrophic failures.