Minimally invasive total knee arthroplasty Research
Key words minimally invasive
Minimally invasive (minimally invasive surgery, MIS) total knee replacement began in the 20th century, late 90's, Repicci and Romanowski in unicompartmental knee
replacement (unicondyhr knee arthroplasty, UKA) used the MIS approach, with less bleeding, postoperative pain and light activity from the bed early, after a short recovery time, etc., thus arousing the people some of minimally invasive knee
replacement surgery and of great interest to 〔1,2〕. Their work for the minimally
invasive total knee replacement surgery basis. This paper summarized the literature in recent years, minimally invasive TKA following review.
The definition of a minimally invasive TKA
Currently on the minimally invasive total knee replacement surgery's report was more, but there is no clear definition of the uniform. Minimally invasive TKA should meet the following conditions: (1) skin incision length <14 cm 〔3〕, but it must be
-term effects can not be blind pursuit of a
small incision. (2) try to avoid damage and disrupt the extensor device 〔4〕
(quadriceps sparing, QS). (3) try to avoid flipping the patella. (4) The operation to
avoid knee dislocation, that is in-situ for the femur and tibia osteotomy 〔5〕.
Two minimally invasive TKA indications and contraindications 〔6〕
Size and severity of deformity in patients with surgical operation and postoperative results have a significant impact, so the choice of patients with the following principles should be followed. Minimally invasive TKA far mainly applied to body weight less than 100 kg, knee activity of at least 105 ?, discreet digital X ray film before and after
the knee-degree varus deformity of less than 10 ?, valgus deformity of less than 15 ?, flexion contracture deformity of less than 10 ? in patients with osteoarthritis of the knee. Elderly patients ( "80 years old), can not tolerate a long period of operation; knee
joint in patients with soft tissue contracture, surgery revealed the difficulties, are not
3 minimally invasive TKA surgical technique highlights 〔5〕
3.1 reduced the length of the incision
Standard TKA incision length of 20 ~ 25 cm, while the minimally invasive TKA for 6 ~ 14 cm, this surgical operation the surgeon must have a learning curve, with the surgical experience increases, the length will be shortened gradually.
3.2 through knee flexion and extension revealed surgical field
In a limited incision, the need to pay attention knee flexion and extension in order to achieve satisfactory exposure of the knee. The back of the knee joint flexion exposed structures such as: After the joint capsule, posterior cruciate ligament; stretching in
front of the knee joints exposed structures such as anterior cruciate ligament, meniscus anterior horn and so on. Rather than by extending the incision exposed the entire joint.
3.3 Use of a retractor
This technology is the basic method of minimally invasive surgery that is, "moving window" technology. Retractor incision in the exposed side of the other side when you release. For example, the minimally invasive TKA surgeon loosened retractor exposing the inside of the lateral joint space, allowing a better exposure to surgical area, not that bad cause soft tissue injury, and vice versa.
Dalury and Jiranek 〔7〕 applications into the road or under the medial quadriceps patellar next to the entry road trip 24 cases of bilateral total knee replacement. The results show that micro-surgery approach under quadriceps pain, early functional
recovery more effective than the contralateral medial patellar into the path beside the effect is good.
3.5 patellar the upper and lower releasable joint capsule