Public Perceptions of Minimally Invasive Total Knee Arthroplasty
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Published on: September 7, 2022
Bradley Q Fox1, Michael P Bolognesi1, Thorsten Seyler1
1Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Introduction:
In the United States (US), minimally invasive surgery (MIS) for total knee arthroplasty (TKA) has been increasingly marketed to patients despite meta-analyses demonstrating equivalent mid-term (two to five years) outcomes. The objective of this study was to evaluate public expectations regarding the extent of soft-tissue disruption and postoperative outcomes for MIS versus traditional approaches.
Methods:
An online questionnaire was distributed to 304 US adults who had a mean age 51 years (range, 40 to 77). Survey questions evaluated layperson knowledge, expectations, and trade-offs regarding incision size, muscle sparing, postoperative pain, and functional status between MIS and traditional techniques. Paired Wilcoxon signed-rank tests were used to compare differences in perceived soft-tissue disruption and postoperative outcome milestones between MIS and traditional approaches. All analyses were repeated after weighting by age group, sex, and education level according to US Census data.
Results:
A MIS was perceived as significantly less invasive, with lower expected soft-tissue disruption (3 versus 7 on a 10-point scale; P < 0.001), smaller incision size (two versus five inches; P < 0.001), and 89% reporting they would be upset if an MIS TKA involved removal of the meniscus and anterior cruciate ligament. Respondents expected significantly lower postoperative pain with MIS at all time points, from one week to one year, and faster recovery for functional milestones, including ambulation, return-to-work, and feeling "normal" (P < 0.001). Also, 94% of respondents prioritized "long-term function" over incision size, and 85% preferred "surgical accuracy" over "faster recovery." Results persisted for weighted analysis against US Census-derived age groups, sex, and education level.
Conclusion:
The US public perceptions of advertised MIS TKA were largely contrary to clinical evidence. Given the misconceptions that currently exist, targeted attention should be given to ensuring accuracy in public-facing marketing materials and preoperative educational content.