Minimally Invasive Surgery or Total Knee Replacement

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Lvc595

junior member
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69
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Female
I have heard that MIS is easier and less invasive with a shorter re-coup time.
Then I heard about gender knees. I am a woman, 54 yrs and need both knees replaced. I just don't know what the qualifying factors would be.
I know there is a difference in the size of the incision. There are some doctors that said I wouldn't qualify for MIS- but then I am not sure if that Dr. practiced MIS or only Total Knee. I heard about the Zimmer knee but then I would have to go to the Dr. who worked with that manufacturer.
It's big business to have a TKR- I'm just not sure what to trust.
Anyone have Dr. they know and trust in the SF Bay Area?

Anyone have both done at the same time? If not how long after the first one did you have the second?
 
As I understand it the first couple weeks are easier but after that it does not make much difference. I also heard that chance of infection is a little higher. My Dr. said that I was not a good candidate because of the condition of my knee. I think the best approach is to find a Dr. that you like and trust and let him do what he is comfortable doing.
 
Welcome Lvc595! Exjock has the right idea. You need to find a good surgeon that you trust and go with what they recommend. Quite a number of folks here on the forum have had both knees done at once (benefit: only one recovery period) and others have done one at a time. The length of time between the two surgeries probably will depend on your surgeon's desires and how you progress after the first surgery.

Here is a link to some questions to ask the doctor(s) you are considering:

https://bonesmart.org/forum/showthread.php?t=713

Your will be able to find lots of support here as you go through surgery and recovery.
 
Both my husband and I used a MIS OS... who came highly recommended and who we trust completely. I am 69 years old and now 4 months post-op. I hope I can answer some of your questions by describing my surgery and recovery... my scar is 4 1/2" long and fading nicely. I didn't have staples or stitches... the closure was on the inside.

In the afternoon of my morning surgery, I was able to raise my leg up, by myself, get out of bed myself (with the PT standing beside me) and walk down the hall with a walker. By evening, I was walking with crutches. By the next morning, I was walking with a cane. My surgery was on a Monday morning, I was discharged on Wednesday noon, with a waterproof Tagaderm dressing.

I was able to take a shower once I was home. I took the usual medications, an anti-inflammatory, Lovenox, pain meds. The in-home PT visited on Friday after my surgery and after giving me a list of exercises to do, we walked outside, 1 block up and 1 block back to the house. By the following Monday, I was walking downstairs gingerly, one step at a time and no longer using the cane in the house. After 2 weeks, I gave up the cane entirely.

As I said, I'm 4 months post-op and still taking an anti-inflammatory because I'm still slightly swollen. I'm also taking an Ultram in the am and another in the pm. A month ago, I tried doing without the two meds but found I still needed them. I will try doing without again soon.

My husband's experience with the same OS, was pretty much the same as mine... he had 2 TKR's, 4 months apart.
Sandy
 
Thank you for your emails.

If you are still swollen did the dr. want to drain your knee? I find that is the most uncomfortable part when I've had knee surgery. Would they drain a knee replacement? 4 months seems to be a long time. I'm glad you are walking. I am really stressed and mad at myself for having to go through this.
 
Thank you for the list of questions.. I will print this out. I can't think when I am stressed.
I go to the surgeon in March.
 
Lvc595.....try not to worry. This is a BIG decision and all of us were stressed out beforehand to some degree. Stay focused on the idea that you will get your life back and that is the important thing.
 
Swelling that occurs after a TKR is in the tissues, not fluid in the joint so draining would be neither possible nor necessary!

Indicators against an MIS are obesity, excessive joint damage/deformity and other health problems. Generally speaking, an MIS takes a bit longer than a standard TKR as it's not so straightforward to place the implants or, indeed, even get them into the joint through the smaller incision.

<edited out>
 
Jo... I think you're talking about laparoscopy surgery, sometimes called a "key-hole" surgery, which is a type of MIS, where there are anywhere from 2 to 4 small incisions. And, you're correct, a knee prosthetic wouldn't fit into a .5 to 1.5 cm incision. In the U.S. laparoscopic surgeries are being used more and more for removal of an appendix, a gallbladder, ovaries, but not for TKR's. My TKR was definitely an MIS. In the U.S. MIS-TKR's use a 4" to 5" incision. My surgery lasted a little over an hour. Oh... I forgot to mention in my last post, one of the big advantages of an MIS-TKR is little or no cutting of tendons, ligaments and quads, hence the recovery is usually faster.
Sandy
 
No, I'm not talking about that! I do know the difference between laparoscopy and MIS which was first developed to do MIS THRs where the incisions really are only about 2½-3" long. However, I did mistype the 2" long incision! That was a typo!

Nevertheless, a 4½" incision in a knee is still more properly a 'reduced incision' TKR which is actually used by many surgeons. It's also common for TKRS to be performed through midway incisions about 6/7" long. The 'traditional' incision is often 12/14" long.

But these are largely semantics. My point was that though MIS/reduced incision seems an appealing option, it's not everybody that will be suitable. There may be contraindications which rule it out as a choice.
 
Jo...

You wrote:

"Actually, what Sandy has described is more a reduced incision rather than a true MIS which has 3-4 incisions about 2" long but do not ask me how they get the prostheses in! Darned if I know but they do. Of course, these true MIS are more suited to hemi or partial replacements."
_______________________________

Jo, this is not how I understand MIS TKR. The way I understand it, there's a single incision, typically about 4-5 inches long. The same prostheses are usually used as in traditional TKR. However, various manufacturers (especially Zimmer) have developed instruments and procedures, and provided OS training, for MIS TKR. I also read a lot about quad-sparing as well. Can you tell me whether all "MIS-TKR" is also quad-sparing, and whether traditional TKR "spares" the quads? And can you shed any light on the "mid-vastus" or "sub-vastus" approaches that I read about in some of the MIS articles on the web?

Here's an example of a description of quad-sparing MIS TKR. You can find a lot more if you google "MIS quad-sparing TKR" and "mid-vastus" or "sub-vastus."

broken link removed: https://www.orthop.washington.edu/uw/tabID__3376/print__full/ItemID__7/mid__0/Articles/Default.aspx

An update--I postponed my TKR in December, because the knee felt so much better. I've been managing on synvisc (or othovisc) injections now for going on two years. I now feel so good that yesterday my husband and I went to the freebie day (parking and admission free) pro-am practice round at the Buick Invitational at Torrey Pines in LaJolla, CA. I must have walked pain-free for miles, up and down hills, on the golf course. As long as I can do that, I'm going to delay TKR.

Lois
 
Well, the fact is that almost every surgeon has his/her own individual way of approaching TKR. They all make variations in the basic formulae put out by the firms so you rarely get two the same. I think I explained how this works in another thread. So trying to pin a procedure down to one description or another is not really prodcutive. Therefore, I apologise for that post which I shall remove. It's just confusing the issue, I think.

Short answer is, the professional definition of MIS hasn't been proven as a usable procedure for TKR (unlike THR) and therefore most use the reduced incision version are still calling it MIS. Actually, I'm rather guilty of inserting the kind of red herring usually debated at length by surgeons with too much time on their hands! My apologies!
 
I had a total knee replacement on both knees...14 months apart. The incisions are no more than 4 inches or 4 1/2 in length. I had no staples ...both were glued which meant no further maintenance, and I am 2 weeks post op today on my left and have been walking without assistance of any kind for 3 days...even walking the dog in the neighborhood! So I am not sure what the difference is between what I had and MIS, but I am thrilled with my progress and whatever it is, I think it's great! Maybe it's the "reduced incision TKR' that Jo mentioned. Also, for whatever reason, my scar from my first TKR 14 months ago is not really that visible! Hoping for the same this time!
 
That's a great and very encouraging report, kanoneli! Thank you.
 
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