Minimally Invasive Total Knee Arthroplasty

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Osteoarthritis of the knee
  • Rheumatoid arthritis of the knee
  • Pain that interferes with activities of daily living
  • Failure of conservative treatment
CONTRAINDICATIONS
  • 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
EQUIPMENT
  • 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
ANATOMY
  • 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.

PROCEDURE
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POST-PROCEDURE
CARE
  • 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.
COMPLICATIONS
  • 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
RESULT ANALYSIS

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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