Minimally-Invasive Surgery (MIS) Quadriceps-Sparing Total Knee Replacement: New Quad Sparing Technique May Provide Faster Recovery for Patients with Arthritis of the Knee.
Edited By: Seth S. Leopold, M.D.
Last updated Tuesday, April 15, 2008
Figure 19 - The skin incision for minimally-invasive quadriceps-sparing total knee replacement is typically about 4? in length, compared to about 8? or more for traditional total knee replacements. Figure 20 - In minimally-invasive quadriceps-sparing total knee replacement, the incision is much shorter, the kneecap is not everted, and the important quadriceps muscle and tendon are not divided. This may permit faster rehabilitation after knee replacem Figure 21 - In traditional total knee replacement, the quadriceps tendon is divided along its length, and the kneecap is turned outward (everted, or ?dislocated?) in order to gain access to the knee joint. This photo shows a total knee replacement done thr About the procedureTechnical details Minimally-invasive quadriceps-sparing total knee replacement surgery
begins by performing a sterile preparation of the skin over the knee to
prevent infection, followed by inflation of a tourniquet to prevent
blood loss during the operation.
Next, a well-positioned skin incision – typically about 4” in length
(see figure 19), though this varies with the patient’s size – is made
down the front of the knee just adjacent to the kneecap, and the knee
joint is inspected and preliminary ligament balancing is performed.
Next, specially-designed alignment rods and cutting jigs – which are
smaller and easier to pass through the smaller incision than those used
for traditional total knee replacement – are used to remove enough bone
from the end of the femur (thigh bone), the top of the tibia (shin
bone), and the underside of the patella (kneecap) to allow placement of
the joint replacement implants. Proper sizing and alignment of the
implants, as well as final balancing of the knee ligaments, all are
critical for normal post-operative function and good pain relief.
Again, these steps are complex, and considerable experience in
minimally-invasive knee replacement is required in order to make sure
they are done reliably, case after case. Provisional (trial) implant
components are placed, without bone cement, to make sure they fit well
against the bones and are well aligned; at this time, good
function--including full flexion (bend), extension (straightening), and
ligament balance--is verified.
Finally, the bone is cleaned using saline solution and the joint
replacement components are cemented into place using
polymethylmethacrylate bone cement (see figure 20). The surgical
incision is closed using stitches and staples. Anesthetic Total knee replacement may be performed under epidural, spinal, or
general anesthesia. We usually prefer epidural or spinal anesthesia,
since these can help provide pain relief in the days following surgery,
and allow faster, more comfortable progress in physical therapy.Length of minimally-invasive (quadriceps-sparing) total knee replacement No two knee replacements are alike, and there is some variability in
operative times, but a typical total knee replacement takes about 60-80
minutes to perform when traditional techniques
are used, because the wider exposure permits more rapid progress
through the technical steps of the procedure (see Figure 21).Surgery for knee arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call the Bone & Joint Surgery Center at 206-598-3354 or Eastside Specialty Clinic at 425-646-7777 to make an appointment.
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