Presentation on theme: "Minimally Invasive Surgery of the Knee, Shoulder"— Presentation transcript:
1Minimally Invasive Surgery of the Knee, Shoulder Bennett Orthopedics & SportsmedicineRegenerating the Youth in You!Minimally Invasive Surgery of the Knee, ShoulderWilliam F Bennett MDOrthopedic Surgeon
2There is a move to perform surgery through smaller incisions Impetus-lower infection rate?less pain?quicker rehab?public demandmarketingproduct companies
3Arthroscopy vs Arthroplasty Arthroscopy-The use of a fiber optic device and mirrors to project an image onto a television screenArthroplasty- replacing defective joints with implants, or other techniques to remodel the joint surface.
18However, Joint Replacement can not be done arthroscopically However, demand has pushed us to use smaller incisions and preserve anatomy
19OsteoarthritisThis knee would not be amenable to arthroscopic intervention
20Mini Incision/Quad Sparing TKR Smaller skin incisionDoes not disrupt the quadriceps tendon, important for knee strengthLess time in hospitalQuicker to walk
21Principles of MIS TKA Address all types of arthritic path. Approach both varus and valgus kneesProvide early, exceptional analgesiaAllow early hospital discharge and rapid rehabilitationThe quality of the outcome not compromised by length of incisionBUT NOT FOR ALL KNEES!!!!!!!!!!!!!!!!
26MIS TKA Intra-operative Minimizes interruption of N/V tissue Minimizes dissection -muscles, tendon,lig .Avoids quadriceps disruptionAvoids disruption of the suprapatellar pouchEliminates patella eversionReduces incision length to 7 to 10 cmDecreases blood lossPost-operativeFaster return to activities of daily living (ADL)Greater range of motion (ROM) during first six monthsLeg raises and flex the knee within 6 hoursReduced pain
27Mini-Incision Hypothesis Mini TKAStandard TKALength 20-30cmExtensive quad violationPatellar eversionLateral releasePROM PTLeg raise by POD ?Ambulate POD 13 - 5 days (Mean = 3.6)Blood lossMorbidity riskLengthy rehabLength 9-14cmcm Quad splitMuscle relaxationRelease lateral pat-fem ligamentPROM PTStraight leg raise on POD 1Ambulate POD 1Flex to 90 by D/C< 3 days (Mean = 2.9) Blood loss Tourniquet & OR timeDecreased morbidityQuicker return to ADLReduced pain (? significant)Cosmetic appealExposureRehabLOSOtherFactorsReported by Dr. Luke Vaughan – Vail 2003
28Quad-Sparing Hypothesis MIS TKAStandard TKALength 8-12cmNo VMO violationNo patella eversionEarly mobilizationLeg raise on day of surgeryFlex to 90 on day of surgeryAmbulation day of surgery1 - 2 days½ blood lossDecreased morbidityFaster return to ADLReduced painCosmetic appealLength 20-30cmExtensive quad violationPatellar eversionPROM PTLeg raise by POD ?Ambulate POD 13 - 5 daysBlood lossMorbidity riskLengthy rehabExposureRehabLOSOtherFactors