| Minimally Invasive Surgery:
replacement is a surgical procedure in which a damaged joint is
replaced with an artificial joint called a prosthesis. Made of metal
alloys and high-grade plastics, the prosthesis is designed to move
just like a healthy human joint. Over the years, knee replacement
techniques and instrumentation have undergone countless improvements.
Today, TKR is one of the safest and most successful types of major
surgery; in well over 90% of cases it is complication-free and results
in significant pain relief and restoration of mobility.
Minimally invasive total knee replacement refers to several surgical
techniques to perform knee replacement using a smaller incision.
Various approaches for minimally invasive hip and knee surgery have
been described. To date, many studies fail to confirm improved outcomes,
and indeed, a number of potential disadvantages of minimally invasive
joint replacement have been reported. These disadvantages relate
to the difficulty of performing such surgery within a restricted
visual field. The disadvantages may include implant malposition,
injury to skin and soft tissue, fractures, or damage to the implants
OCV Position on Minimally Invasive Joint Replacement:
OCV physicians rely on scientifically proven techniques that emphasize
long term outcomes rather than length of incision. That being said,
we have been performing minimally invasive total hip procedures
for over six years. We also perform less invasive knee replacements
on select patients. The techniques we use allow flexibility to enlarge
the approach when needed, to insure the best possible operation
for each patient.
OCV physicians continually refine surgical techniques, incorporating
technology as it is scientifically proven to be better.
OCV surgeons regularly attend scientific meetings, and engage in
research to fine tune every aspect of joint replacement. As minimally
invasive total knee replacement techniques are proven to be safe
and effective, they will be offered to our patients.
Are OCV surgeons CERTIFIED to perform minimally invasive surgery?
There is no recognized certification for minimally
invasive joint replacement. Therefore, we feel that advertising
certification is misleading and unethical.
OCV surgeons are trained and knowledgeable in minimally invasive
joint replacement techniques. Our surgeons have laboratory and hands
on training and experience with several minimally invasive hip and
knee techniques, as well as a variety of implants. The OCV surgeons
were invited to present their experience with minimally invasive
procedures to other surgeons at the West Virginia Orthopedic Association
and Southern Orthopaedic Association meetings.
and Ethics of Minimally invasive knee replacement:
Doctors at the Orthopaedic Center of the Virginias adopt new technology
and techniques that are proven to be safe and effective. Minimally
invasive total knee replacement is a recent surgical innovation
which remains experimental at this time. Minimally invasive knee
replacement is currently a controversial topic for orthopaedic surgeons
Advertisements for minimally invasive total knee replacement include
promises of less pain, less blood loss, and faster return to function.
At present, minimally invasive techniques for total knee replacement
do not meet the ethical standards met by existing knee replacement,
and therefore should be regarded as research until the procedure
has been scientifically validated. OCV surgeons believe that the
widespread use of a new technique should be delayed until the indications,
pitfalls, and potential complications have been identified.
Unlike conventional TKR, minimally invasive surgery (MIS) is performed
through a 4 to 5 inch incision. The amount of muscle and tendon
disruption may also be reduced. The diseased joint surfaces are
replaced with artificial components. Early scientific reports suggest
that minimally invasive procedures may improve early return to function.
No significant mid or long term benefit has been identified. None
of the studies to date are sufficient to show that the minimally
invasive techniques are comparable to, let alone superior to conventional
It is important to also note that TKR remains a major surgery and
significant complication, while rare, can occur. Minimally invasive
surgery generally takes additional time to complete and involves
a more restricted visual surgical field.
Published opinion on Minimally Invasive Knee replacement
and Computer Assisted Surgery: JBJS
The Journal of Bone and Joint Surgery (JBJS) is the most highly
regarded, peer reviewed journal of orthopaedic surgery. The following
article summarizes the controversy regarding minimally invasive
knee replacement. The article concludes: “At present, minimally
invasive techniques for total knee arthroplasty do not meet the
ethical standards that are already met by existing conventional
techniques. Minimally invasive total knee replacement should therefore
be regarded as research, and consented to as such, until the procedure
has been scientifically validated…”
The Ethical Implications of Recent Innovations in Knee Arthroplasty
-Reproduced with permission
Computer-assisted surgery uses technology similar to GPS (global
positioning) to assist OCV surgeons with accurate alignment of joint
replacement components. The navigation equipment provides the surgeon
with information regarding the alignment and position of the implant.
A number of randomized trials have shown the lower-limb alignment
obtained with use of computer-assisted surgery to be superior to
the alignment obtained with use of traditional methods.