Minimally Invasive Total Knee Replacement

What is a minimally invasive total knee replacement?

A minimally invasive total knee replacement or total knee arthroplasty (TKA) is a surgical procedure performed by an orthopaedic surgeon, usually performed under general anaesthesia and also, in some circumstances, spinal anaesthesia. The aim of a minimally invasive total knee replacement is to completely replace a damaged knee joint with a prosthesis. This is done via a vertical incision of between 10 to 15 centimetres over the knee joint which allows surgeons to remove the entire knee joint surface and measure and place the correct size of metal prosthetic. Minimally invasive knee arthroplasty involves a smaller incision than traditional total knee replacements, resulting in less tissue trauma and postoperative pain, and a more rapid recovery.

Minimally invasive total knee replacement surgery requires a hospital stay of between two to four days. Patients may usually fly home within 7 - 10 days but should make sure long-haul flights are split into shorter journeys and book seats with extra leg-room.

Why do I need a minimally invasive total knee replacement?

A minimally invasive total knee replacement is the recommended procedure for younger, non-obese and otherwise healthy individuals suffering from chronic knee pain caused by osteoarthritis, rheumatoid arthritis, knee joint injury and bony tumours of the knee joint. During a minimally invasive total knee replacement procedure uneven, thin and inefficient cartilage is removed and replaced with a metal, smooth-gliding prosthesis. Minimally invasive total knee arthroplasty is considered to be a therapeutic treatment for some patients with severe knee joint degeneration.

Can I prevent needing a knee replacement?

The number 1 cause of knee joint degeneration is osteoarthritis. Osteoarthritis can be hereditary and prevention of cartilage degeneration is in these cases unable to prevent total knee replacement surgery. If you are looking to arrange this type of surgery, your cartilage is already damaged. Injections into the joint of corticosteroids can reduce swelling and pain but do not improve cartilage tissue. The same applies to pain medications.

Knee pain can often be significantly alleviated in overweight people through significant weight loss. Cartilage degeneration may also be slowed down upon losing 10% or more of body weight as the heavy loads the knees once had to cope with are reduced. 

People who have suffered from a knee injury are also more likely to need knee surgery. Sports players are advised to protect their knees with pads. However, if you are already looking into therapy for painful knees due to cartilage degeneration, the only proven method of postponing surgery is weight loss. Supplements such as chondroitin may play a small role in helping cartilage to regenerate but not to the extent that surgery can be postponed for any significant amount of time.

How do I prepare for a minimally invasive total knee replacement? What can I expect?

Pre-travel minimally invasive total knee replacement preparation

Approximately one month before your minimally invasive total knee replacement procedure you may be asked to lower your food intake if you are clinically overweight. This will lower future stress on the knee joint. You may also be asked to arrange a hip X-ray or scan. During this period, it is worth looking around your home for potential access problems and make adjustments. These adjustments may include the placement of a rail beside the bath, shower or toilet and the relocation of a sleeping area to avoid stairs and allow easy access to the bathroom; these total knee arthroscopy tips will help during your revalidation. In addition, it is extremely helpful to strengthen the muscles of the thighs, hips and upper arms before surgery through gentle, low-impact repetitive exercise. You can ask your local physician or physical therapist for knee surgery exercise advice. Naturally, stopping smoking is always recommended. 

Approximately 2 weeks before your minimally invasive total knee replacement you will need to ask your home doctor to take blood for a preoperative blood test. Remedazo will inform you well beforehand which tests your doctor will need to take blood for. Depending on your age, an electrocardiogram may be required. Some blood-thinning medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.

Admittance to the hospital for minimally invasive total knee replacement preparation

You will be admitted to your chosen clinic on the day of your minimally invasive total knee replacement. Certain people such as those with a very high BMI, breathing difficulties, diabetes or other chronic illnesses usually benefit from spending the night before the operation in a hospital setting. 

The day of your minimally invasive total knee replacement surgery

From midnight of the day before the minimally invasive total knee replacement procedure, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during anaesthesia. If you have planned a spinal anaesthetic, these rules still apply as there is always a small chance that you will need to be sedated or fully anaesthetised. Smokers should stop smoking at least 24-hours before an operation. From midnight and up to 6 hours before your planned anaesthesia time you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the 6 hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medication with a little water. This is administered under the advice of the anaesthesiologist and is therefore permitted.

Approximately 30 minutes to 1 hour before the planned procedure time you will be collected from your room and brought to the operating department either in your bed, on a gurney, in a wheelchair or on foot.

Preoperative minimally invasive total knee replacement surgery preparation requires:

  • An intravenous line

  • A blood pressure cuff placed on the upper arm

  • The completely painless placement of electrodes to the chest to measure heart activity

  • A finger or ear sensor to measure oxygen levels in the blood

  • A spinal or general anaesthetic

At the surgeon’s signal, you will be anaesthetised. 

What happens during a minimally invasive total knee replacement operation?

A minimally invasive total knee arthroscopy takes approximately 90 minutes and is carried out in a supine position. The surgical site is broadly disinfected and sterile drapes placed so that only the knee is visible.  If, for personal reasons, you prefer a single-gender surgical team this can be arranged, although all staff from our carefully-selected clinics are extremely professional and respectful individuals.

During minimally invasive total knee arthroplasty a single vertical incision of between 10 and 15 centimetres in length is made along the middle of the knee. This allows your orthopaedic surgeon to remove the damaged cartilage and the thin layers of cartilage-producing bone from the surfaces of the tibia (shin bone) and femur (thigh bone) that form the knee joint. The orthopaedic surgeon carefully measures the joint surface and the correct size of prosthesis is selected. These metal implants are shaped to mimic the natural, healthy cartilage of your knee joint. Both prostheses are tested and then fixed permanently into place. According to individual requirements, the underside of the patella – the small, rounded plate of bone that can be felt at the front of the knee – is then fitted with a smooth layer of surgical-grade plastic. Finally, a plastic spacer is fitted between the two metallic surfaces of tibia and femur. The spacer creates a very smooth, gliding surface between thigh bone and shin bone and restores pain-free mobility of the joint. In some cases, access to the knee joint may be hindered. This may lead to a slightly larger incision, although your eligibility for minimally invasive surgery will have been checked well before surgery.

At the end of the procedure a hollow and sterile soft, plastic tube with a collecting bottle called a drain is placed through the incision.

What happens after minimally invasive total knee replacement? What can I expect? 

You will be woken by the anaesthesiologist immediately after surgery if you have undergone a general anaesthetic and transported from the operating theatre to the recovery room. Spinal anaesthesia requires that the patient remains in the recovery room until both legs regain sensation and mobility. It is possible that you experience an itching sensation as the products within the spinal anaesthetic wear away. This sensation ends as lower limb mobility returns. During your stay in the recovery room you will be carefully monitored. Minimally invasive total knee replacement patients remain in the recovery ward until they are fully responsive and any pain is well under control. 

When the anaesthesiologist is satisfied with your recovery from the effects of the anaesthetic you will be brought to a surgical ward. Remedazo patients continue to be carefully monitored for a minimum of 24 hours after surgery. Pain medication is given as standard for the first 24-hours and then according to your personal doctor’s prescription. Gradually decreasing doses of pain medication may need to be taken for up to three months after total knee replacement surgery. Arterial lines are usually removed within 12 hours after surgery. Your intravenous catheter will remain in place until you are able to drink and take medication by mouth, while blood-thinning injections will be administered to the stomach area for approximately 12 days after surgery. These injections lower the risk of blood clot formation. The intravenous catheter will continue to administer fluids for approximately 48-hours and your drain will be removed by a trained nurse or doctor approximately 24-hours after your arrival in the surgical ward.

The majority of minimally invasive total knee replacement patients are out of bed within 24-hours of exiting the recovery room. Rehabilitation begins immediately and is under the guidance and care of a trained physical therapist. You will often use a bed-based device called a continuous passive motion machine or CPM. Your physical therapist will teach you how to get in and out of bed and manoeuvre yourself during the revalidation period and nursing staff, crutches and walkers will assist you as you start to walk.

The average hospital stay for a minimally invasive total knee replacement is 3 days. By this time you should be able to bend your knee to a 90-degree angle, dress and bathe without assistance and move around with assistance. You will be transported to your accommodation and supported by your personal Remedazo team until you have safely and comfortably returned home. We will ensure anticoagulant injections are administered during your stay, including the day of your flight home. In theory, air travel is possible the moment you feel comfortable; however, long-haul flights should be split into shorter journeys and you should book a seat with extra legroom. This will help to prevent deep vein thrombosis development and unnecessary pain in the operated knee. Your personal Remedazo team can take care of all special travel arrangements for you.

Long-term postoperative care includes the removal of stitches after 10 to 14 days. This can be done by your general practitioner at home. You will require crutches or similar support for at least 1 month after surgery. You can return to work within 3 to 12 weeks depending on your profession. 

Benefits of minimally invasive total knee replacement

A minimally invasive total knee replacement will help you regain painless mobility in the knee joint, enabling you to enjoy non-contact sports and an outdoor lifestyle, to climb stairs and enjoy a full range of previously painful activities. Around 97% of minimally invasive total knee replacement patients report an increased quality of life and would definitely undergo the same procedure on the other knee should this be necessary. After 20 years of use, around 94% of replacement knee joints continue to function well. 

Disadvantages of minimally invasive total knee replacement

During any surgery, the chance of postoperative infection is a potential risk; all patients are administered antibiotics as a preventive measure before surgery commences. Your chosen clinic’s doctors and nurses are trained to recognise the symptoms of infection very early on. Other short-term risks include bleeding, adverse reactions to anaesthesia, blood clots and breathing problems. It is important you continue to receive your anticoagulant therapy for the full term as recommended by your surgeon and wear compression stockings until you are moving around on a regular basis.

A long-term complication is the loosening of one or both prostheses. We recommend you visit your local orthopaedic surgeon should you notice any instability or returning pain in the operated knee. 

A minimally invasive total knee replacement may require you to make permanent lifestyle changes. It is not recommended to participate in contact sports, winter sports such as skiing or activities in which the knee is often rotated or jerked. However, the painless range of activities one can enjoy after a total knee arthroplasty more than makes up for these restrictions.

Minimally Invasive Total Knee Replacement alternatives

It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.

Minimally invasive total knee replacement surgical alternatives include non-minimally invasive knee arthroplasty; the only differences between these two procedures are a longer incision and the involvement of a larger number of muscles. In some cases, partial knee joint replacement or unicompartmental knee arthroplasty may be possible where only a portion of cartilage receives a prosthesis. The use of corticosteroid injections and painkillers do not treat the degeneration of cartilage and are therefore short-term solutions. Stem cell regeneration of damaged cartilage may be an option. 

Of course, there is no alternative for professional medical advice. Please call us to arrange your free e-consult and the opportunity to speak personally with specialist orthopaedic surgeons. You can discuss the minimally invasive total knee replacement and any alternatives that interest you with them, ask for second or third opinions, and take the first step towards your personalised Remedazo holistic care package.


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