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Minimally Invasive Surgery:

Conventional knee 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 themselves.

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.

Controversy 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 and scientists.

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 knee replacement.

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…”

View / download full article. JBJS: The Ethical Implications of Recent Innovations in Knee Arthroplasty
-Reproduced with permission
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Computer-Assisted Surgery
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.