An article appeared in the July, 2007 Journal of Bone and Joint Surgery entitled "Minimally Invasive Total Knee Arthroplasty Compared With Traditional Total Knee Arthroplasty". The main author is Seth S. Leupold, M.D. from the Department of Orthopedic Surgery at the University of Washington in Seattle.
The conclusion of the article is that minimally invasive Total Knee Replacement seems to facilitate recovery after this operative procedure. The patients who had the minimally invasive approach demonstrated significantly better clinical outcomes with respect to shorter length of hospital stay, higher percentage of patients discharged to home instead of inpatient rehabilitation facility, less narcotic use at 2 and 6 weeks post operatively and less need for assistive devices to walk at two weeks after surgery.
The Journal of Bone and Joint Surgery is one of the most respected and credible orthopedic surgery publications. The journal was founded in 1903 and is the official journal of the American Association of Orthopedic Surgery. The guiding principle of the JBJS is excellence through peer review. There are high standards, professional review and rigid criteria that have to be met before an article is accepted for publication. This is one of the first unbiased articles to appear in a prestigious orthopedic journal confirming the benefits of minimally invasive Total Knee Replacement. Therefore I believe the appearance of this article in the JBJS is highly significant.
Like the author of this article, I began performing MIS Total Knee Replacement in 2004. And just as the author discusses in the quoted article there is a learning curve of at least 25 cases to become more familiar with the technique. Like the author I perform a number of these operations on a monthly basis so that I got the over the learning process in a 3 month period. Over the last 3 years I have performed Minimally Invasive Knee Replacement on most of the patients I treat surgically for knee arthritis.
The components that are implanted are the same for MIS and Traditional Knee Replacement. I always use Surgical Computer Navigation as I believe this improves the accuracy in component position.
In my experience 1 in 4 patients are discharged home after one night in the hospital and most of the remaining patients go home after 2 nights. It is less common for a patient to be hospitalized 3 nights or to be discharged to an inpatient rehab facility. Similarly 25 % of patients are walking without assist in a week and the 70 % are walking without assist at 2 weeks. Most patients are driving in 2-3 weeks.
The results with respect to mobility, knee motion, pain relief and function for activities of daily life after MIS and Traditional Knee Replacement seem to merge around 3-12 months after surgery, however the return of quadriceps strength seems to occur sooner in MIS patients.
In conclusion I found the publication of the article highly significant and supportive of the beliefs of my colleagues who are currently performing minimally invasive Knee Replacement. Surgeons using minimally invasive techniques for Joint Replacement do so because of the greater patient benefits with this procedure.
Sunday, September 9, 2007
Minimally Invasive Total Knee Replacement Facilitates Recovery
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While traveling in Oregon three weeks before Dr. Tarlow was to perform my Knee replacement, I meet a fellow who had knee replacement surgery 3½ weeks prior and walking with minimal use of a cane. He was doing therapy and hoping to be using the stationary bicycle the end of that week. He attributed his speedy recovery to his being in good physical condition although he still had a long way to go. I remember thinking I hope I do that well.
Dr Tarlow preformed minimally invasive Total Knee Replacement surgery on me August 3rd 2007.
Day 2 I walked with the use of a walker and was released from the hospital that evening.
Day 4 I started physical therapy even using the stationary bicycle.
Day 6 I was walking without the use of a walker or cane.
Day 31 I hit my first bucket of golf balls
Day 34 I played 18 holes of golf (using a cart)
My conclusion I used very little pain medication and for the first two weeks only. I found myself to be in much less pain than expected although it took almost 4 weeks for my energy to come back and I still have a ways to go. Physical therapy is very important to regaining motion and getting the muscles strengthened again. I am now looking forward to having my other knee done in November.
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