Alfred J. Tria

Minimally Invasive Surgery for Total Knee Arthroplasty

MIS TKA is in the early stages of development. Many opponents believe that the technique is nothing more than a cosmetic modification of the standard TKA that will lead to more complications and lower patient satisfaction. It is important to respect these comments and to thoroughly address them. Minimally invase surgery is a technique that is not determined by the length of the incision or the cosmetic result. The term minimally invasive should refer to the extent of violation of the anatomic structures about the involved joint. In the knee, the MIS approach should not violate the extensor mechanism and should not violate the suprapatellar pouch. The MIS approach should be capsular and, as such, it should produce less discomfort and a faster recovery. Modifications of the MIS technique that extend the arthrotomy into the extensor mechanism, violate the suprapatellar pouch, and evert the patella while using a limited incision are not minimally invasive. There will certainly be a learning curve to this procedure, and a smaller incision with standard TKA techniques may be the interim step for the surgeon attempting to master the new approach. But it will remain that MIS TKA will only have the true result with the true technique.