Minimally invasive knee arthroplasty: An overview

摘要

Minimally invasive surgery(MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty(UKA).Partial knee replacements were designed in the 1970 s and were amenable to a more limited exposure.In the 1990 s Repicci popularized the MIS for UKA.Surgeons began to apply his concepts to total knee arthroplasty.Four MIS surgical techniques were developed: quadriceps sparing,mini-mid vastus,mini-subvastus,and minimedial parapatellar.The quadriceps sparing technique is the most limited one and is also the most difficult.However,it is the least invasive and allows rapid recovery.The mini-midvastus is the most common technique because it affords slightly better exposure and can be extended.The mini-subvastus technique entirely avoids incising the quadriceps extensor mechanism but is time consuming and difficult in the obese and in the muscular male patient.The mini-parapatellar technique is most familiar to surgeons and represents a good starting point for surgeons who are learning the techniques.The surgeries are easier with smaller instruments but can be performed with standard ones.The techniques are accurate and do lead to a more rapid recovery,with less pain,less blood loss,and greater motion if they are appropriately performed.