Traditional Knee Replacement vs. Minimally Invasive Knee Replacement

Minimally invasive knee replacement is an example of how the medical field is continually evolving and trying to improve outcomes for patients. Though thousands are performed every year, minimally invasive knee replacements are the subject of ongoing research and are not considered standard practice.

In the meantime, patients and doctors must use the knowledge available to make informed choices. The bullet points below summarize much of what we know about the pros and cons of minimally invasive knee replacement surgery.

See also Facts and Considerations for Total Knee Replacement

Advantages of Minimally Invasive Surgery

The advantages of minimally invasive knee replacement surgery include:

• Less damage to the skin and surrounding soft tissue, including muscles, ligaments and tendons
• Less blood loss during surgery
• Less post-operative pain
• Smaller scar

Some patients also have an accelerated recovery and physical therapy schedule, so they can resume everyday activities sooner than patients who undergo traditional knee replacement surgery. ¹ Cheng T, Liu T, Zhang G, Peng X, Zhang X. Does minimally invasive surgery improve short-term recovery in total knee arthroplasty? Clin Orthop Relat Res. 2010 Jun;468(6):1635-48. doi: 10.1007/s11999-010-1285-9. Epub 2010 Mar 13. Review. PubMed PMID: 20229136; PubMed Central PMCID: PMC2865591. ^{, 2} Alcelik I, Sukeik M, Pollock R, Misra A, Shah P, Armstrong P, Dhebar MI. Comparison of the minimally invasive and standard medial parapatellar approaches for primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012 Dec;20(12):2502-12. doi: 10.1007/s00167-012-1944-3. Epub 2012 Mar 15. Review. PubMed PMID: 22419264. However, research shows this is not always the case. ³ Stevens-Lapsley JE, Bade MJ, Shulman BC, Kohrt WM, Dayton MR. Minimally invasive total knee arthroplasty improves early knee strength but not functional performance: a randomized controlled trial. J Arthroplasty. 2012 Dec;27(10):1812-1819.e2. doi: 10.1016/j.arth.2012.02.016. Epub 2012 Mar 28. PubMed PMID: 22459124; PubMed Central PMCID: PMC3413785. ^{, 4} Jarvis SL, Johnson-Wo AK, Onstot BR, Bhowmik-Stoker M, Shrader MW, Jacofsky MC, Jacofsky DJ. Differences between standard and minimally invasive parapatellar surgical approaches for total knee arthroplasty in the tasks of sitting and standing. J Knee Surg. 2013 Aug;26(4):249-56. doi: 10.1055/s-0032-1329718. Epub 2012 Dec 20. PubMed PMID: 23258319. ^{, 5} Varnell MS, Bhowmik-Stoker M, McCamley J, Jacofsky MC, Campbell M, Jacofsky D. Difference in stair negotiation ability based on TKA surgical approach. J Knee Surg. 2011 Jun;24(2):117-23. PubMed PMID: 21874947.

Read more about Exercise and Physical Therapy for Arthritis

Traditionally, another advantage to minimally invasive surgery has been a shorter hospital stay. Patients typically had a hospital stay of 1 to 5 days compared to 3 to 7 days for traditional surgery. However, the lengths of hospital stays are changing for both surgeries. Patients having either surgery may stay in the hospital for only 1 or 2 days or even go home the same day with personalized care.

See also Post-Surgical Knee Replacement Precautions and Tips

Disadvantages of Minimally Invasive Surgery

• The surgeon has a limited view of the joint; it is a technically demanding surgery that has a steep learning curve for surgeons
• Possible increased likelihood that knee components may be poorly fit or misaligned
• Skin and soft tissue can be stretched and torn during surgery
• This surgery typically takes a longer time for surgeons to perform
• This newer, less studied surgical procedure may have unknown potential risks

A patient considering minimally invasive surgery should speak with their surgeon about potential advantages and disadvantages in the context of the patient’s knee arthritis, knee anatomy, overall health and lifestyle.

See Questions to Ask Before Knee Replacement