Q1. Why do some patients who are fit, healthy, relatively young and on top of their physical therapy still require manipulation under anesthesia following minimally invasive TKR (total knee replacement)?
Despite a well done total knee replacement, whether minimally invasive or traditional, some patients may not regain motion. In some instances, this is due to poor compliance with physical therapy or inability to comply with physical therapy due to significant pain. When I see patients with poor progress early postoperatively, I emphasize the importance of physical therapy and regaining motion. If they fail to achieve moderate progress toward this end I will recommend manipulation.
In some patients, there is a tendency to form scar tissue. These patients may also have pain, swelling, and stiffness. This makes their recovery difficult and may require manipulation.
Q2. Is everyone eligible for minimally invasive joint replacement or do some people have to undergo the more traditional approach?
There are several factors that influence a physician’s choice to use a minimally invasive approach to joint replacement. In cases of significant deformity or revision surgery, these corrections are best done through traditional approaches. Operations on large muscular or obese patients are also usually best performed through more traditionally sized incisions. Patients who are at or below average weight and size with no significant deformity usually appropriate for minimally invasive approaches.
Q3. Are there any joints that can’t be replaced using a minimally invasive method?
Joints with significant deformity or complex procedures are best performed through traditional approaches. In some cases a patient’s size may lead a surgeon to consider a traditional approach over a minimally invasive one.
Q4. If a person is overweight and in need of a total knee replacement how many pounds should that person aim to lose prior to surgery to ensure the best possible outcome?
There is no optimal weight for a patient undergoing total joint replacements. Patients who are extremely obese do have higher rates of complications and longer hospitalizations than average-weight patients. For patients who are significantly overweight, I refer them to a weight-loss specialist or to their primary care doctor for management.
Q5. How soon before you can tell if a joint replacement was a success? Is one method of joint replacement more successful than another?
Although minimally invasive procedures have become popular, several months after surgery, the traditional and minimally invasive techniques are indistinguishable.
It is difficult to pinpoint one moment of success for a total joint. I prefer to have patients look at the immediate successes of being discharged from the hospital and achieving the milestones of getting in and out of bed and beginning to tackle stairs and walk in the hall while hospitalized. The next tier is accomplished over the following weeks with restoration of normal daily activities like walking and performing routine activities. The final tier is resuming recreational non-impact activities like golf. This is usually accomplished at three months. Everyone is different, and many patients see small improvements up to one year after total joint replacement.
Dr. Michael Parks is an orthopedic surgeon who performs minimally invasive total joint replacements, knee and hip revision surgery, and alternative procedures including partial knee replacements and arthroscopic surgery of the knee. Dr. Parks emphasizes patient function and pain as a guide to indicate the best individual approach to multiple nonsurgical and surgical alternatives for treatment of arthritis.
