Saving the Knee with Minimally Invasive Prosthesis

Minimally Invasive Knee Prosthesis: What is it?

Minimally invasive knee prosthesis is a surgical procedure primarily aimed at preserving the healthy parts of the joint. This is achieved by implanting a minimally invasive prosthesis that replaces only the worn-out compartment of the knee.

Minimally invasive surgery, using these devices, spares the unaffected parts of the knee, including the anterior and posterior cruciate ligaments. These ligaments are crucial for knee proprioception – the feeling of knowing where your knee is in space – unlike many total knee arthroplasties.

When to Undergo Knee Prosthesis Surgery

The decision to have knee prosthesis surgery is complex and depends on several factors, including:

• The results of less invasive treatments, if previously attempted;
• The severity of osteoarthritis;
• The patient's expectations;
• Their lifestyle, quality of life, and any associated health conditions (diabetes, heart disease, respiratory issues, etc.);

Age is not a determining factor; there's no patient too young or too old for surgery.

Types of Minimally Invasive Knee Prostheses

Unicompartmental Knee Prosthesis

The unicompartmental knee prosthesis replaces only the damaged compartment of the knee. The procedure takes approximately 40 minutes, reducing the risk of infection, blood loss, and the need for blood transfusions.

Recovery allows a return to normal life within 3-4 weeks, although this varies depending on individual needs. The unicompartmental prosthesis comprises a femoral shield (covering the femoral condyle), a tibial component (covering the tibial plateau), and a polyethylene insert.

The polyethylene insert sits on the tibial plateau, enabling smooth movement between prosthetic surfaces. These components are secured with bone cement for optimal fixation. A unicompartmental prosthesis can be implanted in both knees simultaneously, minimizing healthcare costs, anesthesia time, and infection risk, without affecting recovery time.

Femoral Prosthesis

The femoropatellar prosthesis can also be considered minimally invasive or unicompartmental as it replaces only the femoropatellar compartment. Indications are highly selective; it's crucial to ensure the inner and outer femoropatellar compartments are undamaged.

Age and weight are not contraindications for this or unicompartmental femorotibial prostheses. The femoropatellar prosthesis consists of a femoral or trochlear component (covering the femur) and a plastic (polyethylene) patellar component (covering the patella's inner surface). These are cemented to the bone. Bilateral surgery is possible without impacting recovery.

Minimally Invasive Total Knee Prosthesis

The minimally invasive total knee prosthesis is reserved for cases with damage to all three compartments. It's considered minimally invasive as it preserves the posterior cruciate ligament, responsible for proprioception and stability. However, this ligament may be sacrificed in cases of advanced osteoarthritis for increased prosthesis constraint. Severe deformities may also require sacrificing more bone.

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Post-Surgery Expectations

Postoperative Advice

Postoperative care, recommended and discouraged activities, follow-up appointments, and lifestyle adjustments should be thoroughly discussed with the patient. Doctors typically advise weight loss (if overweight) and at least 30 minutes of daily stationary cycling, alongside exercises prescribed by a physiotherapist.

Recommended Physical Activities

Contact sports (martial arts, football, basketball) should be avoided. Tennis, swimming, and golf are preferable, as is hiking. Check-ups with X-rays are recommended at 1, 3, 6, and 12 months post-surgery, then annually, to assess prosthesis placement and polyethylene condition.

Complications

All potential complications should be discussed. Infection is the most common (1-3%, varying depending on the type of prosthesis). Aseptic loosening is another risk (0.5-2%). These percentages are averages; risk factors like diabetes, smoking, previous fractures, and obesity increase the likelihood of complications.

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