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Minimally Invasive Surgery of the Knee, Shoulder William F Bennett MD Orthopedic Surgeon Bennett Orthopedics & Sportsmedicine Regenerating the Youth in.

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Presentation on theme: "Minimally Invasive Surgery of the Knee, Shoulder William F Bennett MD Orthopedic Surgeon Bennett Orthopedics & Sportsmedicine Regenerating the Youth in."— Presentation transcript:

1 Minimally Invasive Surgery of the Knee, Shoulder William F Bennett MD Orthopedic Surgeon Bennett Orthopedics & Sportsmedicine Regenerating the Youth in You!

2 There is a move to perform surgery through smaller incisions Impetus- lower infection rate? less pain? quicker rehab? public demand marketing product companies

3 Arthroscopy vs Arthroplasty Arthroscopy-The use of a fiber optic device and mirrors to project an image onto a television screen Arthroplasty- replacing defective joints with implants, or other techniques to remodel the joint surface.

4 Arthroscopy Setup Uses: Knee- cartilage meniscus ligaments Shoulder- rotator cuff dislocation/instability some arthritis Hip labral tears anterior impingement

5 Arthroscopy Instruments

6 Shoulder Anatomy

7 Bone

8 Arthroscopic Photos Shoulder

9 Shoulder Arthroscopy Shoulder Arthroscopy Rotator Cuff Tears Dislocations/Subluxations Biceps subluxation SLAP Lesions Impingement Ac Joint resection Osteoarthritis

10 Knee Anatomy Bones- – Femur – Tibia – Fibula – Patella

11 Tendons Rectus femoris Vastus Medialis – obliquus Vastus lateralis – Obliquus – Patellar Ligament

12 ACL Ligament

13 Patellofemoral Chondromalcia

14 Knee Arthroscopy Meniscal Repair Meniscal Resection Synovectomy Chondoplasty Ligament Reconstruction Cartilage Regeneration

15 Arthroscopic Biopsy Sent To Cambridge, Massachusetts Grown in Petri Dish Replace Deficit with open procedure Near Future- arthroscopic replacement tissue engineering

16 Cell Implantation

17 Hip Arthroscopy Limited Indications Impingement Labral Tears

18 However, Joint Replacement can not be done arthroscopically However, demand has pushed us to use smaller incisions and preserve anatomy

19 Osteoarthritis This knee would not be amenable to arthroscopic intervention

20 Mini Incision/Quad Sparing TKR Smaller skin incision Does not disrupt the quadriceps tendon, important for knee strength Less time in hospital Quicker to walk

21 Address all types of arthritic path. Approach both varus and valgus knees Provide early, exceptional analgesia Allow early hospital discharge and rapid rehabilitation The quality of the outcome not compromised by length of incision BUT NOT FOR ALL KNEES!!!!!!!!!!!!!!!! Principles of MIS TKA

22 Old Incisions

23 New Incisions

24 NEW INSTRUMENTS NATURAL- LITE MIS – Knee instruments – 4 incision

25 OldNew

26 MIS TKA Intra-operative –Minimizes interruption of N/V tissue –Minimizes dissection -muscles, tendon,lig. –Avoids quadriceps disruption –Avoids disruption of the suprapatellar pouch –Eliminates patella eversion –Reduces incision length to 7 to 10 cm –Decreases blood loss Post-operative Faster return to activities of daily living (ADL) Greater range of motion (ROM) during first six months Leg raises and flex the knee within 6 hours Reduced pain

27 Mini-Incision Hypothesis Length 9-14cm cm Quad split Muscle relaxation Release lateral pat-fem ligament PROM PT Straight leg raise on POD 1 Ambulate POD 1 Flex to 90 by D/C < 3 days (Mean = 2.9) Blood loss Tourniquet & OR time Decreased morbidity Quicker return to ADL Reduced pain (? significant) Cosmetic appeal Standard TKA Exposure Length 20-30cm Extensive quad violation Patellar eversion Lateral release PROM PT Leg raise by POD ? Ambulate POD days (Mean = 3.6) Blood loss Morbidity risk Lengthy rehab Mini TKA Other Factors LOS Rehab Reported by Dr. Luke Vaughan – Vail 2003

28 Quad-Sparing Hypothesis Length 8-12cm No VMO violation No patella eversion Early mobilization Leg raise on day of surgery Flex to 90 on day of surgery Ambulation day of surgery days ½ blood loss Decreased morbidity Faster return to ADL Reduced pain Cosmetic appeal Exposure Rehab Other Factors LOS Length 20-30cm Extensive quad violation Patellar eversion PROM PT Leg raise by POD ? Ambulate POD days Blood loss Morbidity risk Lengthy rehab MIS TKAStandard TKA

29 Small Incision About 4 inches

30 Surgery

31 Summary Patients like the scar Less pain Less blood loss Faster rehabilitation


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