Small incision or minimally invasive Knee
replacements are cosmetically appealing, cut down on post-operative
pain, pain medication, blood loss, shorten hospital stays and help in
faster return of function for patients undergoing TKR in India.
Total knee replacement(TKR) is a very
effective surgical procedure used by orthopedic surgeons in India and
world wide to provide permanent pain relief for osteoarthritis and
rheumatoid arthritis. The previous Indian Prime minister, Shri Atal
Bihari Vajpayee’s bilateral knee replacments three years ago
popularised this orthopedic surgical procedure in India.
Since then the orthopedic procedure has
evolved internationally. Although orthopaedic surgeons were pleased
with their skills and results in terms of improvement in knee scores,
patients continued to experience post op pain for nearly 6 months after
surgery. The pain resulted from the iatrogenic ( surgeon induced)
tissue damage to implant a total knee prosthesis.
In a traditional knee arthroplasty an
artifical knee was implanted under regional or general anesthesia
through a midline skin incsion about 14 cm long in an operation that
lasted about 1 – 1.5 hrs. UK or US trained orthopaedic surgeons in
India perform this in laminar air flow operation theatres in cities
In a minimally invasive knee replacement
the incision is downsized to about 9cm. The quadriceps muscle is not
divided and the patella or knee cap is not flipped over for exposure of
the joint. Besides being cosmetically appealing, post operative pain is
considerably lesser and patients require very little opioid and
analgesic medication. With almost no pain, they can stand up and
ambulate within 48 hrs. As the quadriceps muscle is spared, the
incidence of knee cap dislocations is minimised and the knee has more
strength in earlier follow up although over longer follow ups, there is
no significant difference. Specialised instrumentation insert standard
prostheses. Only the approach is smaller.
Benefit to patients- Patients can stand up
on their feet the same evening and can return home within 2 days( I
mean it not to a rest home or intermediate care facitlity). In Chennai,
the High flex knee from Zimmer has been inserted into 3 knees, and two
have been through a subvastus approach. Post op pain is less and
patients have declined medication for pain relief earlier.
Blood loss is minimal and no transfusion
is required. Muscular strength returns faster and patients are able to
mobilize full weight bearing within 48 hrs without any crutches. In
summary the same standard implants are inserted into the knee in a
minimally invasive replacement with added PATIENT benefits to a
The author is a consultant orthopaedic surgeon in India
and performs minimally invasive knee replacements using the Nex gen
knee from Zimmer.