Minimally Invasive Total Knee Arthroplasty

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  • Osteoarthritis of the knee
  • Rheumatoid arthritis of the knee
  • Pain that interferes with activities of daily living
  • Failure of conservative treatment
  • Obesity
  • Knee flexion of less than 90 degrees
  • Very large bone structure
  • Recent or current knee infection
  • Systemic infection
  • Skin disease overlying the area of the incision
  • Extensor mechanism disruption
  • Significant quadriceps muscle weakness
  • Medical comorbidities that significantly increase the anesthesia risk
  • Significant vascular compromise in the surgical leg
  • Neuropathic arthropathy
  • Leg positioner or two sandbags
  • Intraoperative x-ray machine (optional)
  • Tourniquet
  • Electrocautery
  • Rake retractors
  • Curved retractors
  • Oscillating saw
  • Narrow saw blades
  • Cement mixer and cement
  • Curets
  • Minimally invasive total knee arthroplasty set
  • Knee arthroplasty components of various sizes
  • Small drill
  • Pulsatile lavage irrigator
  • Drain
  • Distal femur
    • Medial condyle: curved to allow rotation during terminal extension
    • Lateral condyle: straighter and has a greater height; can be identified by its terminal sulcus and popliteal groove
  • Proximal tibia: medial condyle is more cup-shaped whereas lateral condyle is more flat.
  • Patellofemoral articulation: medial and lateral patella facets and trochlear notch of femur
  • Static restraints: anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament ; menisci are secondary restraints.
  • Normal tibiofemoral alignment is 5 to 7 degrees.
  • The knee is primarily a hinge joint with rolling and gliding occurring during terminal extension.

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  • Use a compressive dressing.
  • Begin DVT prophylaxis immediately after surgery, including both mechanical devices and medication, such as low molecular weight heparin and/or Coumadin.
  • Begin range-of-motion exercises with or without use of a CPM machine.
  • Begin physical therapy while still in the hospital and continue as an outpatient after discharge.
  • Hematoma formation
  • Thromboembolism
  • Infection
  • Patellofemoral complications
    • Instability
    • Extensor mechanism avulsion
    • Quadriceps or patellar tendon rupture
    • Patellar fracture
    • Patellar component loosening
    • Patella clunk syndrome
  • Neurovascular complications
  • Periprosthetic fracture

Minimally invasive approaches to knee arthroplasty spare the quadriceps muscle and therefore have been associated with increased range of motion, faster mobilization, and decreased pain during the first 4 to 6 weeks after surgery.

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