Ask the Expert: Dr. Parks Answers Your Questions on Minimally Invasive Joint Replacement

Conceptual 3D human man anatomy or health design, joint or artic

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.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. Hi Dr Michael Parks,

    I am 69 years old and I need total knee replacements on both knees. I am constantly in a lot of pain. It is getting to the point that I cannot walk or go upstairs. I have been to other orthopedic surgeons and they would not do the surgery until I lose the weight. I am obese. I am 5 feet 4 inches tall and I weigh 295 lbs. They have advised me to have bariatric surgery, but I don’t know how much longer I can walk without being put in a wheelchair. I really would not want to do the bariatric surgery and then the knee replacements. It would take me time to lose the weight, and I just had xrays on both knees and they have gotten worse from last year.
    Please help me.

    Thank you, Carol

  2. I’m 57 years old with an arthritic hip. I’m trying to postpone surgery as long as possible. How long would you expect me to be able to take Naproxin 500mg 2x day, only when needed for pain and inflammation, before damage to my kidneys and other side effects make surgery the only option? To be clear, I don’t take Naproxin 2x day every day, only when the pain is too much.

    1. Hi Charles, thank you for reaching out. It would be best to consult with a physician to determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  3. I am 43 yrs mom & last May I had artrhoscopic surgery to “clean out” knee & wound up having about 1/3 of the meniscus removed on rt. knee. have been in constant pain since then, Euflexxa did not really help. I’ve since had gastric surgery & so far lost 75 lbs and unfortunately still in constant pain. My doctor does not want me to have the replacement surgery since I’m considered “young” & risks are high?? I can’t continue this way. I’m a mom to 11 yr old twins and need to be active & there for them. any suggestions??? I’ll be contacting for appointment!! Thank you…

    1. Hi Sandra, thank you for reaching out. Dr. Michael Parks, Orthopedic Surgeon, says: “There is a strong association between being overweight and higher rates of osteoarthritis. Congratulations on the weight loss. This weight loss is usually helpful in reducing symptoms of osteoarthritis to some degree. If despite weight loss and attempts at non-operative management including medications, injections, and physical therapy you continue to have significant pain and limitation of function, total knee replacement may have to be considered. The timing for this procedure is best dictated by how severe your symptoms are.” It is best for you to consult with a physician who is familiar with your medical history so they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  4. Hi Dr.
    I am a 62 yr. old active woman and rower.
    20 years ago I had an adductor compartment resection from a deep liposarcoma that was grade 1.
    I had revisions due to seromas 2x.
    I have not have an subsequent reoccurrence, but I do have lymphedema localized in my thigh.
    I manage with overnight compression garments and pressure thigh highs.

    2 years ago I had arthop. surgery for bilater. meniscus tears. All went well.

    I recent had an xray and have bone on bone on the medial border of my knee.

    It was managed for 1 year by cortisone shots. Now efficacy is waning,

    I am in need of a TKR but am concerned about the protocol and results for one such as me with mild-mod lymph.

    I want to get back to rowing and working as an OT.

    Any help would be great.

    Thank you!

    1. Hi Regina, thanks for reaching out. It is best you consult with your treating physician to determine your best course of action. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  5. I have osteoarthritis bone to bone and tear on medial meniscus ligament on my right knee ,I will have total knee replacement . I not obese , I do not know which technic. Is good for me traditional TKR or minimal invasive.

    1. Hi Fatema, thanks for reaching out. To determine the right course of treatment you should be evaluated by an orthopedic surgeon. For more information on total knee replacement, click here: If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  6. An orthopedist has recommended bilateral TKA and shoulder surgery (removal of bone spurs). If both are equally needed, should the shoulder surgery be done first due to the susceptibility of artificial joint to infections?

    1. Hi Walter, thank you for reaching out. Dr. Michael Parks, Orthopedic Surgeon, says: “Whether the shoulders or knees are done first, it really depends on which one bothers you the most. One thing to consider, however, is that the recovery may be a bit more extensive.” It is best for you to consult with a physician who is familiar with your medical history so they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  7. Any suggestions to help me would be greatly appreciated. 70 yo F w/ no add”l med issues. TKR in 1-2011 b/c of torn meniscus. mult comps: blood transf, lymphedema, incisional staph inf, severe internal scar formation, mult failed attempts PT. 2 manips + 1 arthrolysis since. Knee/leg still has sig pain when in use. Pain always improves when I do NOTHING! Any ideas/ Thx so kindly.

    1. Hi Linda- It is best for you to be evaluated by a physician. If you are interested in care at HSS, please call our Physician Referral Service at 877-606-1555.

  8. I enjoy reading through an article that can make people think. Also, thanks for allowing for me to comment!

    1. Hi John ? Thanks for reaching out! Dr. Lawrence Gulotta, HSS Orthopedic Surgeon, says, ?We have done extensive research on the ability of stem cells to augment rotator cuff healing. While the preliminary results are encouraging, its use is still a long way away. HSS is at the cutting edge of research on new ways to improve rotator cuff healing, and will continue to be in the future.?

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