MIS total knee arthroplasty with a subvastus approach

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Citation (Scopus)

Abstract

Performing minimally invasive total knee arthroplasty through a subvastus approach makes sense on an anatomic basis, on a scientific basis and on a practical basis. Anatomically, the subvastus approach is the only approach that saves the entire quadriceps tendon insertion on the patella [1-5] (. Fig. 29.1). Scientifically, the subvastus approach has been shown, in prospective randomized clinical trials, to be superior to the standard medial parapatellar arthrotomy and to the so-called quad-sparing arthrotomy [3, 6, 7] (. Table 29.1). Practically, MIS TKA with a subvastus approach is reliable, reproducible and efficient and allows the MIS technique to be applied to a broad group of patients not just a highly selected subgroup [8] (. Table 29.2). It is now accepted widely that the tenets of minimally invasive (MIS) total knee arthroplasty (TKA) include: a smaller skin incision, no eversion of the patella, minimal disruption of the suprapatellar pouch, and minimal disruption of the quadriceps tendon. To what degree any one of those factors contribute to improvements in post-operative function remains unclear. Our initial attempts at MIS TKA using the short medial arthrotomy (sometimes referred to as the quad-sparing approach) and the mini-midvastus splitting approaches were frustrated by some substantial technical difficulties. We then modified the subvastus approach to the knee to meet the tenets of MIS TKA and found that it markedly facilitated MIS surgery and allowed it to be applied to a broader group of patients. When coupled with instruments designed specifically for small incision surgery the modified subvastus approach is reliable, reproducible and safe. Using a simple set of retractors this procedure can be done without making any blind cuts or free-hand cuts and that enhances surgical accuracy and patient safety.

Original languageEnglish (US)
Title of host publicationNavigation and MIS in Orthopaedic Surgery
PublisherSpringer Berlin Heidelberg
Pages223-227
Number of pages5
ISBN (Print)9783540366904
DOIs
StatePublished - Dec 1 2007

Fingerprint

Knee Replacement Arthroplasties
Patella
Tendons
Minimally Invasive Surgical Procedures
Patient Safety
Knee
Randomized Controlled Trials
Hand
Skin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pagnano, M. (2007). MIS total knee arthroplasty with a subvastus approach. In Navigation and MIS in Orthopaedic Surgery (pp. 223-227). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-540-36691-1_29

MIS total knee arthroplasty with a subvastus approach. / Pagnano, Mark.

Navigation and MIS in Orthopaedic Surgery. Springer Berlin Heidelberg, 2007. p. 223-227.

Research output: Chapter in Book/Report/Conference proceedingChapter

Pagnano, M 2007, MIS total knee arthroplasty with a subvastus approach. in Navigation and MIS in Orthopaedic Surgery. Springer Berlin Heidelberg, pp. 223-227. https://doi.org/10.1007/978-3-540-36691-1_29
Pagnano M. MIS total knee arthroplasty with a subvastus approach. In Navigation and MIS in Orthopaedic Surgery. Springer Berlin Heidelberg. 2007. p. 223-227 https://doi.org/10.1007/978-3-540-36691-1_29
Pagnano, Mark. / MIS total knee arthroplasty with a subvastus approach. Navigation and MIS in Orthopaedic Surgery. Springer Berlin Heidelberg, 2007. pp. 223-227
@inbook{cf91d0d5fd5441ef99e665eae943ac53,
title = "MIS total knee arthroplasty with a subvastus approach",
abstract = "Performing minimally invasive total knee arthroplasty through a subvastus approach makes sense on an anatomic basis, on a scientific basis and on a practical basis. Anatomically, the subvastus approach is the only approach that saves the entire quadriceps tendon insertion on the patella [1-5] (. Fig. 29.1). Scientifically, the subvastus approach has been shown, in prospective randomized clinical trials, to be superior to the standard medial parapatellar arthrotomy and to the so-called quad-sparing arthrotomy [3, 6, 7] (. Table 29.1). Practically, MIS TKA with a subvastus approach is reliable, reproducible and efficient and allows the MIS technique to be applied to a broad group of patients not just a highly selected subgroup [8] (. Table 29.2). It is now accepted widely that the tenets of minimally invasive (MIS) total knee arthroplasty (TKA) include: a smaller skin incision, no eversion of the patella, minimal disruption of the suprapatellar pouch, and minimal disruption of the quadriceps tendon. To what degree any one of those factors contribute to improvements in post-operative function remains unclear. Our initial attempts at MIS TKA using the short medial arthrotomy (sometimes referred to as the quad-sparing approach) and the mini-midvastus splitting approaches were frustrated by some substantial technical difficulties. We then modified the subvastus approach to the knee to meet the tenets of MIS TKA and found that it markedly facilitated MIS surgery and allowed it to be applied to a broader group of patients. When coupled with instruments designed specifically for small incision surgery the modified subvastus approach is reliable, reproducible and safe. Using a simple set of retractors this procedure can be done without making any blind cuts or free-hand cuts and that enhances surgical accuracy and patient safety.",
author = "Mark Pagnano",
year = "2007",
month = "12",
day = "1",
doi = "10.1007/978-3-540-36691-1_29",
language = "English (US)",
isbn = "9783540366904",
pages = "223--227",
booktitle = "Navigation and MIS in Orthopaedic Surgery",
publisher = "Springer Berlin Heidelberg",

}

TY - CHAP

T1 - MIS total knee arthroplasty with a subvastus approach

AU - Pagnano, Mark

PY - 2007/12/1

Y1 - 2007/12/1

N2 - Performing minimally invasive total knee arthroplasty through a subvastus approach makes sense on an anatomic basis, on a scientific basis and on a practical basis. Anatomically, the subvastus approach is the only approach that saves the entire quadriceps tendon insertion on the patella [1-5] (. Fig. 29.1). Scientifically, the subvastus approach has been shown, in prospective randomized clinical trials, to be superior to the standard medial parapatellar arthrotomy and to the so-called quad-sparing arthrotomy [3, 6, 7] (. Table 29.1). Practically, MIS TKA with a subvastus approach is reliable, reproducible and efficient and allows the MIS technique to be applied to a broad group of patients not just a highly selected subgroup [8] (. Table 29.2). It is now accepted widely that the tenets of minimally invasive (MIS) total knee arthroplasty (TKA) include: a smaller skin incision, no eversion of the patella, minimal disruption of the suprapatellar pouch, and minimal disruption of the quadriceps tendon. To what degree any one of those factors contribute to improvements in post-operative function remains unclear. Our initial attempts at MIS TKA using the short medial arthrotomy (sometimes referred to as the quad-sparing approach) and the mini-midvastus splitting approaches were frustrated by some substantial technical difficulties. We then modified the subvastus approach to the knee to meet the tenets of MIS TKA and found that it markedly facilitated MIS surgery and allowed it to be applied to a broader group of patients. When coupled with instruments designed specifically for small incision surgery the modified subvastus approach is reliable, reproducible and safe. Using a simple set of retractors this procedure can be done without making any blind cuts or free-hand cuts and that enhances surgical accuracy and patient safety.

AB - Performing minimally invasive total knee arthroplasty through a subvastus approach makes sense on an anatomic basis, on a scientific basis and on a practical basis. Anatomically, the subvastus approach is the only approach that saves the entire quadriceps tendon insertion on the patella [1-5] (. Fig. 29.1). Scientifically, the subvastus approach has been shown, in prospective randomized clinical trials, to be superior to the standard medial parapatellar arthrotomy and to the so-called quad-sparing arthrotomy [3, 6, 7] (. Table 29.1). Practically, MIS TKA with a subvastus approach is reliable, reproducible and efficient and allows the MIS technique to be applied to a broad group of patients not just a highly selected subgroup [8] (. Table 29.2). It is now accepted widely that the tenets of minimally invasive (MIS) total knee arthroplasty (TKA) include: a smaller skin incision, no eversion of the patella, minimal disruption of the suprapatellar pouch, and minimal disruption of the quadriceps tendon. To what degree any one of those factors contribute to improvements in post-operative function remains unclear. Our initial attempts at MIS TKA using the short medial arthrotomy (sometimes referred to as the quad-sparing approach) and the mini-midvastus splitting approaches were frustrated by some substantial technical difficulties. We then modified the subvastus approach to the knee to meet the tenets of MIS TKA and found that it markedly facilitated MIS surgery and allowed it to be applied to a broader group of patients. When coupled with instruments designed specifically for small incision surgery the modified subvastus approach is reliable, reproducible and safe. Using a simple set of retractors this procedure can be done without making any blind cuts or free-hand cuts and that enhances surgical accuracy and patient safety.

UR - http://www.scopus.com/inward/record.url?scp=84895216093&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84895216093&partnerID=8YFLogxK

U2 - 10.1007/978-3-540-36691-1_29

DO - 10.1007/978-3-540-36691-1_29

M3 - Chapter

AN - SCOPUS:84895216093

SN - 9783540366904

SP - 223

EP - 227

BT - Navigation and MIS in Orthopaedic Surgery

PB - Springer Berlin Heidelberg

ER -