Minimally invasive technique in total knee arthroplasty--history, tips, tricks and pitfalls

Minimally invasive surgery (MIS) in Total Knee Arthroplasty (TKA) has been evolving since the early 1990s and was first described by several authors from the USA in early 2003-4. The evolution was driven from patients and clinicians alike and the technique has been used by several experienced knee surgeons worldwide. Although the procedure is demanding and the learning curve long, the benefits outweigh the difficulties faced during the learning process. Our experience with minimally invasive techniques started in 2003. At the beginning only a few procedures were carried out as rigorous exclusion criteria were applied. However, as confidence grew the number of operations has significantly increased. The average surgical time for minimally invasive technique is longer than for the standard technique, particularly in the early stages. More attention needs to be paid to the alignment, sizing and positioning of the prosthesis. According to our early experience, functional recovery is faster with MIS compared with standard technique. The MIS group achieved better knee flexion during the first three months (average of 116 degrees ) compared to open access surgery (average of 97 degrees ). There was no significant difference in alignment and component sizing between the two groups.