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Minimally Invasive TKR

Discussion in 'Knee Replacement Pre-Op Area' started by Baja24, Oct 25, 2010.

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  1. Baja24

    Baja24 Junior Member

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    I was wondering how many out there had their knee replaced using minimally invasive surgery? If so do you feel that it really cut down on the time it took to rehab the knee?
     
  2. Tykey

    Tykey Forum Advisor

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    What's minimally invasive surgery?

    I've always wondered , because they still have to get in there with the saws, drills and hammers, and get the lumps of metal glued in place:pzld:
     
  3. skigirl

    skigirl Moderator

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    My surgeon uses Minimall Invasive Surgery (MIS). I believe in it 100%. My incisions are 4 inches long--and the stem of my tibial prosthesis is shorter than the usual ones.

    My surgeon works with Stryker and they have developed some special tools for him to use while using such a small incision. He also uses computer assisted navigation which helps to make sure that there are not misalignments. He does about 300-400 knees a year.

    What you do not want is MIS surgery from someone who is new at it or who wants to try one!! You must have a knee specialist who is more than well trained in this type of surgery.

    I think that the first three months are easier with this surgery. It does not give any advantages for length of recovery or really, ultimate outcome, in my opinion. However, having an easier first three months was well worth it to me. You really cannot see my scars unless the light is just right, which I like since I do not like to talk about TKR with strangers.

    For me, I had a GA, got up about 20 min after I got back from the recovery room to go to the bathroom. I walked without a walker or a cane--I had to use crutches in the hospital!! But put them away as soon as I got home. I stayed two days, walked out on my own.

    My bend was 90 in the hospital, did not use a CPM since my doc said they were useless after you get 90 degrees. Was 100 at four weeks--am 150 now.

    At four week I started going on regular 20 mile bike rides. Always used an outpatient pt--I drove myself after 10 days. I used Percoset for the first two weeks, 1 every four hours, after that I dropped to one every six hours for probably another two weeks or so. After that, I used it late in the evening. Stopped all narcotics at three months.

    This is a difficult surgery and you are flat on your back for the first two weeks--but, I think the MIS helped me to get to the outcome that I have. Kelly
     
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  4. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Minimally Invasive Surgery is actually generally deemed to be keyhole surgery, similar to what is done to do an arthroscopy. So that is clearly not a possibility in a knee replacement as the implants are too big and they have, as Tykey pointed out, to use jigs and saws! So the approach that is actually used is a 'reduced incision' such as Kelly has described.

    Overall, and despite what some erstwhile surgeons say on their websites, the recovery is pretty much the same regardless.

    Plus it's not possible to do even 'reduced incision' approaches on legs that belong to us larger folk!
     
  5. much2do

    much2do Junior Member

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    We'll see.. My OS prides himself & group on doing MIS. He says there is less muscle cutting etc. and that recover is much easier/quicker..

    My first knee will be 11/17/10.

    skigirl, I am impressed! If I can do 1 mile on my bike after 4 weeks I'll be astonished
     
  6. Tykey

    Tykey Forum Advisor

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    Thanks everybody for explaining what minimally invasive surgery is:thmb:

    I always thought it was a type of keyhole surgery, which it obviously isn't. You always learn summat new on 'ere:wink:
     
  7. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    All of which is true but it doesn't alter the fact that MIS (keyhole surgery) is not what they do. It's reduced incision surgery. It will probably be about a 4" incision.
     
  8. kneesrus

    kneesrus Sr Bonesmartie

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    Hi everyone,
    I am on board with skigirl. I have an inside or medial incision. The OS used retractors to move the knee cap out of the way. Went to work on upper and lower components, and then put a new surface on the knee cap. I not going to say, I recovered quicker because of the technique. When I woke up, I knee what to do for recovery. I had a morphine pump working, so I wrapped the sheet around my ankle and pull back as far as I could, then iced it down. I did that until they removed the pump. I also have a Stryker knee.
    There is nothing in the medical literature that states one knee is better than another. It is all on the OS preference and what he has had good out comes.
    David
    L TKR 12/19/07
     
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  9. cotton1958

    cotton1958 Supremo

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    Sounds like a TKR to me. I think that's what my Doctor did, but I didn't know to use a sheet to start the excercises when I woke up. Used a CPM and had inflated foot pumps. So why does this surgery make it a MIS or not? I am more confused. : / I had ice and a Dilaudid pump.
     
  10. Jamie

    Jamie Administrator

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    It IS a TKR, Helen. It's just that some surgeons practice a technique where they make a smaller incision. It is a little more difficult to work in a tighter space, but the theory is that recovery may be a bit easier. I'm not sure that's always true, but the scar will be smaller for sure. It's not a technique all surgeons do nor is everyone a good candidate for it.
     
  11. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Base line is, the incision has to be big enough for the jigs and the implants to be attached to the bones. They will make the smallest incision they can but that and the size of the leg are the governing factors (meaning the fatter the leg, the bigger the incision!)
     
  12. Tykey

    Tykey Forum Advisor

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    That's what I thought as well. A bog standard TKR?

    Is the size of the incision the important factor here.? Don't they still have to do the same amount of cutting/sawing/hammering etc, but they just manage do do it through a smaller hole.

    So does it really make any difference, apart from a surgeon being able to claim they are special?

    One day you'll get used to my cynicism:D
     
  13. kneesrus

    kneesrus Sr Bonesmartie

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    Hi Helen,
    MIS or not. Some OS think it is a gimmick. Some OS want to be to continue to improve their technique. I get a variety of patients with old school and new tech. I would have to say, some of the old school patients take a little longer to have a good out come. It really comes down to the OS and what they are comfortable with and what have been their outcomes. Is one better than the other. The statistics do not back that up. There is not a best way.
    David
    L TKR 12/19/07​
     
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  14. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Couldn't have put it better myself, David! :thmb:
     
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