Rush University Medical Center First to Perform Minimally Invasive Total Knee Replacement Surgery as Outpatient

Link  https://www.rushortho.com/news_knee.cfm

Chicago - The same minimally invasive surgical techniques that were developed for hip replacement surgery are now being applied to total knee replacement surgery, in most cases dramatically reducing time in the hospital, pain and recovery. In the present study, Dr. Richard A. Berger, an orthopedic surgeon at Rush University Medical Center, reported that 92 percent of his patients who have minimally invasive total knee replacement surgery are able to leave the hospital and go home the same day.

Dr. Berger, one of the pioneers of the first minimally invasive hip replacement surgery using two small incisions, is also the first surgeon to perform the innovative minimally invasive total knee arthroplasty (TKA) as an outpatient procedure. Developed in conjunction with Zimmer, a manufacturer of orthopedic reconstructive devices, the procedure is called the MIS Quad-Sparing Total Knee Procedure because it avoids cutting muscles and tendons in the knee during surgery.

A similar procedure has been performed with partial knee replacement and is now being successfully performed for complete knee replacements by Dr. Berger and Dr. Aaron Rosenberg at Rush. The MIS Quad-Sparing total knee procedure is performed through one small three- to four- inch incision instead of a large, eight- to 12-inch incision. This approach has the potential for dramatically reducing pain by sparing muscles and tendons that historically have been cut during standard TKA surgery.

"Using new tools and minimally invasive surgical techniques, we avoid cutting through the quadriceps tendon and muscles and replace the damaged knee through a three- to four-inch incision, rather than the standard eight- to 12-inch incision down the front of the knee." Berger says the minimally invasive approach translates into potentially great benefits for the patient. The quadriceps muscles and tendon control the function of the knee. The cutting of the quadriceps tendon and muscles in standard surgery causes much of the pain the patient feels during rehabilitation after standard total knee replacement surgery. Also, scarring and adhesions that form while the tissues heal can cause pain, swelling and stiffness during rehabilitation.

Because the quadriceps tendon and muscles are not cut during minimally invasive TKA, other potential benefits of the procedure include increased range of motion sooner after surgery, faster recovery, less blood loss during surgery, and a shorter hospital stay as 92 percent of patients leave the hospital the same day.

Dr. Alfred J. Tria, Jr. of New Jersey and Dr. Thomas Coon of California were the first to perform the MIS Quad-Sparing total knee procedure. Dr. Berger and Dr. Rosenberg have worked closely with Dr. Tria and Dr. Coon to develop the specialized instruments and the surgical technique required for this procedure. And Dr. Berger was the first to perform the procedure on an outpatient basis.

These surgeons are beginning to train other surgeons on this technically demanding procedure through the Zimmer Institute, based in Warsaw, Ind., which includes a satellite training location at Rush University Medical Center.

"These benefits may allow quicker return to work and daily activities," says Dr. Berger. "Patients generally have a two- to four-week recovery time with the minimally invasive surgery, versus two to three months of recovery time with traditional knee surgery."

More than 250,000 TKA surgeries were performed in the United States last year. Minimally invasive quadriceps-sparing TKA is an option for most patients who are candidates for standard TKA. Using modified techniques and instruments, surgeons can place the same, clinically proven implants used in standard surgery, but through a much smaller incision and without cutting through the quadriceps tendon and muscles.

Candidates for total knee replacement experience painful arthritis in the joints, including the knee. Over time, the cartilage that cushions the joint deteriorates, causing pain and stiffness when knee bones rub directly against each other. Knee pain originally may be felt when the person is bending or putting pressure on the knee - while walking or going up and down stairs - but eventually may be nearly constant. Pain medications and walking aids may help temporarily, but the only long-term solution is knee replacement.

Factors that may rule MIS TKA out for some patients include variation in knee structure (i.e., being extremely knock-kneed or bow-legged), prior knee surgery on the same knee, obesity, a recent history of deep vein thrombosis (DVT) or other unstable medical conditions.