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Minimal incision surgery is a plastic surgery technique which requires highly developed, specialized skills. If these techniques are used indiscriminately and/or with underdeveloped skills, the results can be extremely unsatisfactory and the technique itself may become the subject of disrepute. After testing a wide range of applications for 15 years, the authors found a limited number of conditions suitable for correction by MIS techniques. In some cases, however, it allows a somewhat wider range of application than any non-MIS technique. For example, in cases of severe scar formation and compromised vascularity, any other form of surgery could be too traumatic, or, in the elderly, too disabling. Therefore, these techniques can often bring relief with safety to a greater segment of the population than otherwise possible. Benefits are numerous, including certain safety factors. There appears to be an increased protection from scarring, nerve entrapment, infection, pain, and extended disability. Certain cosmetic benefits are also acceptable and attractive to the patient.
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PMID:Minimal incision surgery. A plastic technique or a cover-up? 293 21

Recent attention toward minimally invasive approaches to joint replacement has resulted in new MIS TKA techniques for the implant of conventional TKA implant components. These proposed techniques must be evaluated thoroughly and changes approached with caution. Medial and lateral techniques that minimize interruption and dissection of neuro-vascular tissues, muscles, tendons, and ligament shave been described. Patients who have undergone these procedures have benefited short term from quicker recovery time and less pain and have benefited long term from the use of conventional prosthesis. Before MIS can become an accepted surgical technique for TKA, a clear understanding of the unique guiding principles behind MIS TKA must be understood and realized. Once these basic principles are followed and the surgeon is familiar with MIS TKA techniques, this technique should prove to be a substantial step forward in the continuum of TKA procedure development.
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PMID:Minimally invasive total knee replacement: principles and technique. 1506 9

Total knee replacement traditionally has been done through an anterior incision approximately 18 cm long, using a capsular incision that separates the interval between the rectus femoris and vastus medialis musculature. Although giving excellent exposure, this incision also disrupts the suprapatellar pouch and may lead to adhesions and difficulty with rapidly regaining flexion. It is hypothesized that, by using a more minimally invasive incision, there will be a more rapid return of flexion and the patient will require fewer narcotic medications postoperatively. This retrospective review compared 32 total knee replacements done through a minimally invasive mini-midvastus approach with 26 total knee replacements done through the standard medial parapatellar approach. Preoperative Knee Society scores and postoperative functional outcomes were compared. Postoperative flexion was measured daily during hospitalization and at a 6-week and 3-month followup. Pain was assessed by a visual analog scale and the amount of pain medication used during hospitalization. Implant position was measured. The MIS group had an average skin incision length of 12.8 cm. Passive flexion on a daily basis was significantly higher in the MIS group compared with the standard group. At 6 weeks postoperatively, the change in Knee Score was statistically higher in the MIS group and the average visual analog pain score and the total amount of pain medication was lower. The radiographic alignment and position of all the components was normal in all patients in both groups. The limited disruption of the extensor mechanism results in more rapid restoration of the quadriceps muscle control.
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PMID:Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. 1553 22

This study was performed to determine whether differences existed between primary knee replacement performed through a standard medial parapatellar approach, and those performed through a minimally invasive mini-mid vastus approach. It was a prospective study compared with a retrospective evaluation of a matched cohort. In this study, the Genesis(tm) II and its MIS instrumentation were used. Patients with the mini-mid vastus MIS incision (MMV MIS) required less pain medication post-operatively, regained their flexion more rapidly, and attained their functional milestones at an earlier point than those with the traditional median parapatellar long incision. Despite the smaller incision, component placement was radiographically excellent in all cases. Optimal performance of the surgery required the use of special instrumentation, modified so as to be used in smaller incisions.
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PMID:Minimally invasive total knee replacement using a mini-mid vastus incision technique and results. 1574 95

The use of computer navigation in orthopedic surgery allows for real time intraoperative feedback resulting in higher precision of bone cuts, better alignment of implants and extremities, easier fracture reductions, less radiation and better documentation than what is possible in classical orthopaedic procedures. There is no need for direct and repeated visualization of many anatomical landmarks (classical method) in order to have good intraoperative orientation. Navigation technology depicts anatomy and position of "smart tools" on the screen allowing for high surgical precision (smaller number of outliers from desired goal) and with less soft tissue dissection (minimally invasive surgery - MIS). As a result, there are more happy patients with less pain, faster recovery, better functional outcome and well positioned, long lasting implants. In general, navigation cases are longer on the average 10 to 20 minutes, special training is required and equipment is relatively expensive. CAOS applications in knee and hip joint replacement are discussed.
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PMID:Computer assisted orthopaedic surgery -- CAOS. 1653 71

The authors evaluated results of 136 consecutive minimally invasive total knee arthroplasties (MIS TKAs). The first 22 knees, performed with strict patient selection criteria, were determined as a learning experience. According to results of the next 114 knees, the average wound length was 9.2 centimeters and the average blood loss was 470 milliliters. At a mean follow-up of 14 months, the mean Knee Society score improved from 37.5 to 96 points with 96.3% of excellent results. Sixty-five knees, group A, had within 10 degrees of varus and 49 knees, group B, had more deformity. Clinical results of both groups were not statistically different in terms of operative time, blood loss, pain score, postoperative knee flexion at 2 weeks and 6 months and postoperative day of walking. However, the ability to straighten the knee was significantly delayed in knees with more deformity (group B). After gaining learning curve, surgeons could extend performing MIS TKA in patients with more knee deformity.
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PMID:Results of the 136 consecutive minimally invasive total knee arthroplasties. 1662 7

The MIS anterolateral approach for hip replacement surgery uses the intermuscular plane between gluteus medius and tensor fascia latae. The patient is placed in the lateral position. Retractors with soft tissue friendly profile and an operating table with modified leg support are recommended. The technique provides very good exposure of the acetabulum and femur and preserves muscle integrity so that rehabilitation can be rapid. Currently the experience comprises over 1000 primary cases performed using the MIS anterolateral approach since March 2003. The clinical results including pain, blood loss, range of motion, functional score, Harris Hip Score, and radiographic studies are based on the complete examinations of 48 consecutive patients. There are significant differences with improved clinical results compared with patients after standard approaches. After a fundamental learning curve there is no evidence of increased complications. The anterolateral approach is a standard approach suitable for wide application. The experience includes difficult primary cases like dysplasia, rheumatic disease, and ankylosis and even for revision surgery the technique can be routinely used. Restrictions are not known either in patients' characteristics or in indications.
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PMID:[The MIS anterolateral approach for THA]. 1671 90

This prospective study aimed to compare the clinical and radiologic results achieved using navigation-assisted minimally invasive surgery (NA-MIS) and conventional techniques in 42 patients who underwent bilateral total knee arthroplasty (TKA), with a minimum 1-year follow-up. Patients who underwent NA-MIS TKA showed better Hospital for Special Surgery (HSS) Scores and Western Ontario MacMaster (WOMAC) total scores for up to 6 months postoperatively than patients who underwent conventional TKA, and lower WOMAC pain score for up to 9 months postoperatively. Range of motion (ROM) was comparable in both groups at all times. More patients preferred the NA-MIS procedure to the conventional procedure. Radiologic results for the NA-MIS group showed fewer outliers than did results for the conventional group, but not in mean values.
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PMID:Functional results of navigated minimally invasive and conventional total knee arthroplasty: a comparison in bilateral cases. 1740 43

This study was undertaken to compare the clinical and radiological results achieved using navigation-assisted minimally invasive surgery (NA-MIS) and conventional (CON) techniques in 42 bilateral total knee arthroplasty (TKA) patients with a minimum follow-up of one year. Clinical evaluations were performed using range of motion (ROM), Hospital for Special Surgery (HSS) scores, and Western Ontario and McMaster University (WOMAC) scores (pain, functional, and total) at 3, 6 and 9 months and one year postoperatively. Patients' subjective preferences and radiological indices, including mechanical axis and coronal inclinations of the prostheses, were compared at one year postoperatively. NA-MIS TKA yielded better HSS and WOMAC total scores than CON TKA up to six months, and a better WOMAC pain score up to 9 months. However, these differences were not significant at one year postoperatively. ROM was comparable in both groups at all times, but more patients preferred the NA-MIS side to the CON side. Radiological results showed no differences in mean values between the two surgical groups, although the NA-MIS group contained fewer outliers than the CON group. In conclusion, NA-MIS TKA was associated with better clinical results up to 6 or 9 months after surgery, giving more accurate leg alignment than CON TKA.
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PMID:Comparison of functional results with navigation-assisted minimally invasive and conventional techniques in bilateral total knee arthroplasty. 1753 92

From April 2003 to April 2004, the records of 24 patients who underwent primary total hip arthroplasty (THA) through an anterolateral mini-incision technique (MIS group) were reviewed. They were matched by diagnosis, gender, average age, and body-mass index to those with a traditional-incision technique (control group). The clinical significances in terms of operative time, blood loss, pain level and length of stay were compared. Mean patient age in the MIS group (12 patients) was 56 years; 9 patients were women. Average body mass index was 24.6. Mean operative time was 113 minutes. Average incision length was 8.3 cm for the initial incision. Fifty percent required extension of the incision length, which became 9 cm after wound closure. Mean length of hospital stay was 11 days. Average intraoperative blood loss was 504.2 mL and postoperative drain output was 491.7 mL. Average blood transfusion was 0.8 units. Ninety-two percent of patients required only one oral analgesic for pain control. Mean visual acuity score (VAS) was 1.8 on postoperative day 3. When compared with the control group (average incision length of 15), statistically significant differences (P < .05) were noted in terms of intraoperative blood loss, length of stay, and VAS. Anterolateral mini-incision technique for primary THA is a safe method without ignificant complications.
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PMID:Minimally invasive total hip arthroplasty in a Chinese population. 1759 94


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