Has Anyone Had MIS TKR instead of Standard?

[Rockgirl4]

So I definitely know I've having the Minimally Invasive, Quad-Sparing TKR (4-5 inch incision) instead of the Standard TKR (10 inch incision and cutting of quad muscle). It's the standard for where I'm having my surgery, and my surgeon does loads of them.

I'm mainly curious if anyone has had the supposed faster, easier recovery and return to activity. I'm not getting my hopes up, as I know I'm a slow healer and hang on to swelling for awhile, but a girl can hope, right??!!

 

[Roy Gardiner]

Hmm. To the best of my limited knowledge the cutting of the quad is an old fashioned technique now rarely if ever used.

 

[SusieShoes]

Cutting the quad is rarely done anymore. “Quad-Sparing” surgery is a marketing spin. My OS and I talked about that at length. Just saying that makes the surgery sound like a “better” surgery — even if that’s what EVERY surgeon does.

Your incision will be the size needed to get the implant into your knee. The pieces, alas, do not lend themselves to tiny laparascopic incisions (maybe someday). My incisions are about six inches long. Some people, particularly women with smaller bones/knees, will have smaller incisions, but most will be in the six to ten inch range no matter what kind of TKR surgery they have (custom implants, robotic assistance, traditional).

Many members here have had robotic and custom implant surgeries, both of which do lead to somewhat faster early recoveries. I qualify that as “earlier” recoveries because every TKR, no matter how performed, still requires a full year to heal. The first weeks to couple months might be slightly easier, though. I hope some of these members stop by. Maybe @Jajakio?

Hope away! I hoped new knees would improve my life. And... yeah! They did!

 

[KathyO23]

Hi @Rockgirl4
I just had the Smith & Nephew http://www.smith-nephew.com/profess...s/journey-ii-total-knee-system/journey-ii-xr/ at HSS in NYC. One week ago today. Then incision is 4.5 inches which has dissolving sutures and glue (dermabond)
I was discharged the following day.
My ROM before leaving was 92’ with all the anesthesia .... I’m walking around the house 5 min at a time (or less) and doing mainly isometric exercise and flex bar. Also, trying to keep ahead of the pain, sometimes not too easily. Meds... Tylenol, Mobic, aspirin, and oxy once or twice a day, it helps at night.

Good luck with your surgery Dec 18
I have my ACL and PCL Dr. Mike Ast is my OS

Kath

 

[Jajakio]

When I interviewed surgeons, I met with a surgeon who did what he called quad sparing surgery. He has a video which shows a side incision which appears to be 4 or 5 inches long (my current incision is about 6 inches long and dead center on the knee). I was told there was less cutting and things were slid aside rather than cut and healing time would be quicker. It seemed plausible and I gave him serious consideration. In the end I opted for the Conformis custom knee and a different surgeon so I have no practical experience with it.

As far as quick healing goes, the conformis also promises a quicker recovery. I found that to be true for me very early on. I could pedal a bike in PT in less than 2 weeks, I was back to work part time by 5 weeks, I was off all meds but Tylenol in under a month. I think my first 10 or 12 weeks were well ahead of the curve but at a certain point everyone else caught up and I think I was in good shape but far more typical by 6 months. It did take me nearly a year to get back to "normal" and at 16 months I'm surprised that I'm still getting a bit more ROM. Still, anything to get through those rough first few months better. Overall my experience was very positive and I would choose it again. Hopefully your experience will be similar and the early quick healing will be a plus.

 

[Rockgirl4]

Thanks to everyone for the comments. I was told my incision would be ~5 inches, but I have big knees/bones, so I won't be surprised if it's longer. They're going in my old incision from the ACI back in 2015, and they don't "think" they'll need to open it the entire length. If they do, I won't mind. I just want my new parts.

Can you tell I'm still super anxious about the post-op pain levels being uncontrolled like after my ACI in 2015??? I know I need to get a grip and stop worrying about it, but I think I keep analyzing everything in hopes that this will be less painful. Either way, I can't change it!

Thanks again, as I always learn something new from you all.

 

[Jaycey]

Your first priority while still in the hospital is to work with staff to get your pain management cocktail just right. If one medication isn't working, ask for an alternative. Everyone reacts differently to medication. But your post op pain should be controlled once you leave the hospital. Icing and elevating will also help.

 

[kmak81230]

My surgeon advertises "minimally invasive" but they have to get that implant in there somehow so it's all pretty invasive IMHO. I agree with Susie that it's probably a marketing ploy. Mine is customizable and I was told it lends itself to a shorter time in surgery since it all fits quite nicely and they have little adjusting on the spot but who knows? My incision is 7" long. I got off the narcotics pretty quickly but I think that's pretty individual as well. Regardless, it's a bit of a slog of a recovery if you ask me. Best wishes for a good recovery. . .

 

[Celle]

"Minimally invasive" and "Quad sparing" are indeed marketing ploys.

While it is true that the side-entry used by surgeons claiming the above can lead to a faster recovery at first, complete recovery will still take a full year.

The days when surgeons routinely snipped the quads are long gone. Nowadays, the quads are only snipped very rarely, because of exceptional circumstances.

The size of your incision will depend on how much shaping of your bones your surgeon has to do and ,of course, the incision will have to be large enough to allow for complete access to your knee joint and insertion of the implants.

I have had three knee replacements, the last two being computer-assisted. My largest incision is 8 inches long. It was originally only 6 inches, but it had to be extended when I had a revision.

Since your surgeon has a history of success with the approach that he uses, I think you can have confidence in him, and I wish you a successful surgery and recovery.

 

[SusieShoes]

Can you tell I'm still super anxious about the post-op pain levels being uncontrolled like after my ACI in 2015???

I'm an analytical type too and wanted ALL the information. And like you I was quite anxious about post-op pain because I'd heard from people about it being the "worst ever" and I have quite the imagination, so I was imagining THE WORST PAIN and dreading it. It didn't help that when I expressed my anxiety, my OS told me he held back on opioids. Oh no! I despise opioids (they are miserable drugs that make me sick) but they really help with pain. So I was anxious about that, too. What if I couldn't get opioids (and I don't even like them)? Everything induces anxiety when one is anxious.

I was quite pleasantly surprised by how good my pain control was after surgery. Yours is likely to be excellent also. And you might be surprised by post-op pain. It may not be as bad as you fear. My pre-op pain was pretty horrible, so I mostly found post-op pain to be not much worse. And best of all... it only got better as time went along.

 

[Rockgirl4]

@SusieShoes My husband keeps saying something similar---that the anxiety is just getting me more worked up as the weeks go by. This is one reason I didn't want to wait until May and opted for December. I knew no one would be able to live with me another 7 months. I keep telling myself daily that even if the worst happens, and it IS as bad as the last time, I survived that and will survive this too. I'll just have more tools in my arsenal this time (like awesome icing and elevation!!).

Thanks again for everyone's input. I can't promise I won't panic again before Dec. 18 though.

 

[Josephine]

I'm mainly curious if anyone has had the supposed faster, easier recovery and return to activity.

Seen a hundred members here who had that surgery with high hopes of those promises. So far as I can recall, most had a pretty ordinary recovery just like everyone else!

I suggest you read this to see our take on good pain management
Pain management: importance of managing pain after a TKR and the pain chart