Minimally Invasive Knee Replacement is Safe/Better: Refuting the Wall Street Journal

The October 14, 2008 edition of the Wall Street Journal published an article entitled "New Doubts About Popular Joint Surgery". The following excerpt from the WSJ raises issues concerning Minimaly Invasive Joint Replacement surgery (MIS).

"But patients aren't always told that minimally invasive surgery is more difficult to perform than a traditional operation. Because of the smaller incision, surgeons have a harder time seeing what they are doing. And because minimally invasive surgery has grown so fast, many doctors don't have extensive experience performing the complicated procedure."

As an experienced MIS Knee Replacement Surgeon I completely agree with the above quoted comments. However, the other side to the story is that experienced surgeons using computer surgical navigation have patients with consistently excellent outcomes and complication rates as low or lower than traditional joint replacement surgeons.

I would like to address the three issue raised. First, "minimally invasive surgery is more difficult that a tradition joint replacement". There is a known "learning curve" of approximately 25 cases, after which most surgeons will have mastered the MIS technique. I have been performing MIS Total Knee Replacement since 2004 and to date have over 500 cases experience. The transition to MIS replacement will occur with time and can be compared to the transition in sports medicine from open "traditional" knee and shoulder surgery in the past to current arthroscopic treatment for most knee and shoulder injuries.

Secondly, "because of the smaller incision, surgeons have a harder time seeing what they are doing". Using Computer surgical navigation intraoperatively or computer generated surgical cutting blocks preoperatively provides the Minimally Invasive Joint surgeon with the information needed to accurately place the new hip or knee joint using the smaller incision. Computer technology more than overcomes the exposure issue raised in this second point. I personally do not perform MIS Total Knee Replacement unless I have computer navigation or computer generated cutting blocks.

Third, "because minimally invasive surgery has grown so fast, many doctors don't have extensive experience performing the complicated procedure". Every major city and some smaller towns have compentent, experienced minimally invasive joint replacement surgeons. As a patient, do your research and find the well trained, experienced minimally invasive joint replacement surgeon and you will often times be rewarded by a faster recovery and a less painful experience while getting all the long term benefits of traditional total joint replacement.

Patient Matched Total Knee Replacement - The Next Great Thing for Knee Replacement Surgery

Computer Design is utilized to advance Total Knee Replacement Surgery. Patient specific anatomic data derived from MRI scans and long standing knee xrays are used to fabricate custom surgical instruments (cutting blocks). The custom blocks (see photo) are applied to the patient's bones for Patient Matched Total Knee Replacement, which precisely sizes and positions the knee components. This represents an improvement on Computer Navigated Surgery because the computer is now being used prior to surgery to pre plan the bone resection using a three dimensional model. This results in placement and sizing of the total knee specifically for each patient. The surgery is customized and the placement of the knee components are precise. This Patient Matched technology is only available at limited locations in the U.S. (Dr. Tarlow is authorized to use this technology at Scottsdale Thompson Peak).

This Smith and Nephew technology may be superior to the Otis Med technique because the Patient Matched Total Knee Replacement restores the knee to the "gold standard" neutral mechanical axis (straightens deformed legs).

Patient benefits with the Patient Matched Total Knee Replacement include MIS (minimally invasive surgery) techniques, reduced operative and anesthesia time, shorter hospitalization, and speedier recovery.

The Journey Knee design is the first and only of it's kind. Designed from the ground up from a clean slate by a team of engineers, knee rotation, translation and flexion are restored to near normal parameters. Modern design tools created a knee with unique design features resulting in superior stability, strength and flexion. Patients remark the Journey knee provides better knee motion and feels more like a normal knee compared to other knee designs.

The use of Oxinium as the metal for the Journey knee further improves the Patient Matched Total Knee, making this ideal for the younger and more active patient. Oxinium is a metal with a ceramic surface that has outstanding wear resistance. Oxinium, with it's superior wear characteristics, may be a superior material for Total Knee Replacement in the younger, active patient.