A few words about “Minimally Invasive” joint replacement surgery.

Many of my patients ask about a “new technique” they saw on TV, or an “alternative to traditional joint replacement that uses a small incision”.

If it sounds to good to be true it usually is.

But Less Invasive surgery is real and potentially beneficial.

Understand that Minimally invasive and mini-incision surgery are not the same thing! A small incision does not determine what goes on under the skin. In fact, most patients undergoing joint replacement surgery don't care how long the incision is, they want a pain-free, well functioning, durable joint replacement. Minimally invasive surgery means that there is minimal trauma and disruption to normal tissue in the process of performing the surgery. Our current technique typically does result in a much smaller incision but this is a pleasant benefit – not the goal!

There is no such thing as “minimally invasive” joint replacement surgery! That’s because the most “invasive” part of the surgery is also the most necessary part of the surgery – that is: removing the arthritic bone and cartilage and replacing it with a new prosthetic joint. Joint Replacement surgery by definition therefore cannot be “minimally invasive”. But it can be “Less Invasive” than it has been in the past. So even though we call these techniques “Minimally Invasive”, it is somewhat of a misnomer.

Since the actual joint replacement part is “invasive” and cannot be avoided, what can be modified to make a surgery less invasive? First of all, unnecessary damage and disruption to the skin, muscle, tendons, ligaments, and bone around the joint can be avoided. Minimizing the dissection and trauma to these surrounding structures make a procedure less invasive. If no muscle is cut, the surgery is less invasive. If less bone is removed, the surgery is less invasive. What are the potential advantages to the patient of less invasive surgery? Quicker surgery, quicker recovery, less rehab, less post op pain, and shorter hospital stay.

Is everyone a candidate for less invasive joint replacement? Most people who are joint replacement candidates will benefit from these new techniques. We us a subvastus, cementless knee replacement technique that is custom fit to your size and stature. No muscle is cut at all in this technique and in most cases you keep your own kneecap. We can do Less Invasive Hip Replacement surgery using an incision on the back of the hip or on the front depending on the situation. Again, using these techniques almost no muscle is cut.

Here is the best part: Patients are up walking the day of surgery. Most patients go home in 2 days. I find it hard to believe myself sometimes, but it is true that some patients are able to go home the next day!

At The Louisville Bone and Joint Center, we routinely perform minimally invasive knee and hip replacement surgery. My choice of implants and instrumentation is conducive to the technique. We use bone-conserving implants, including partial knee replacements when appropriate and hip replacements that preserve and respect the good bone – we recently proved this in a laboratory study that measures the amount of bone removed using different types of hip replacements. I continue to be actively involved in helping to design joint replacements and instruments so that we can minimize trauma to the tissue around the joint. Yes, our incisions are much smaller than what they used to be, but more importantly, we minimize the unnecessary trauma and damage to important structures around the joint, which ultimately results in a better experience for the patient. That is what “minimally invasive” joint replacement is all about. You still get better, but now you get better quicker and easier.

We are constantly seeking new ways to benefit our patients – Minimally Invasive Joint Replacement is just one more way.

Cyna Khalily, MD
The Louisville Bone and Joint Center, PSC