Surgical exposure for total knee arthroplasty: for everything there is a season

The author has used a mini midvastus lesser-invasive knee approach for 5 years for patients undergoing a primary total knee arthroplasty. The approach involves a modified capsular and muscular incision, displacement but not eversion of the patella, and avoidance of anterior dislocation of the tibia before bony resections. This has resulted in a more rapid return of flexion and functional ability with a lesser amount of postoperative pain as compared with previous larger median parapatellar approaches with patellar eversion. The approach is indicated for patients who preoperatively have good knee flexion, a mild to moderate coronal deformity, and no prior open procedures on the joint. It is difficult to use in patients who have large, heavy and/or muscular thighs; those with severe angular or flexion deformities; those with limited flexion; and those with severe inflammatory arthritis of the knee.