Minimally invasive surgery (MIS) has been a hot topic for the last several years as it becomes a more common approach to a variety of procedures. Performed through smaller incisions, proponents claim that MIS results in less pain, less blood loss, a shorter hospital stay and a faster recovery. New techniques, instruments and even new prostheses also have been developed for use in minimally invasive surgeries.
In many instances, all of this might be true. I also believe that the final incision should appear as if a plastic surgeon has closed it. However, what is most important is the attention to detail beneath the incision. The length of an incision and a “great looking scar” are not substitutes for the best surgical outcome and recovery.
Many well-respected hip and knee reconstruction surgeons have expressed concern about some MIS procedures. A number of studies have reported inferior results with increased complications from MIS as compared to standard approaches.
Clearly, the ultimate goal of creating a knee or hip reconstruction is to relieve pain and implant a long-lasting prosthesis which allows the individual to engage in activities about which he or she is passionate. Accomplishing this through a smaller incision with less dissection is even more advantageous only if it doesn’t compromise the ultimate goal.
At the Leone Center for Orthopedic Care, I always perform as minimally invasive a surgery as possible, making the final incision appear as aesthetically pleasing as possible. However, with total hip and knee replacements, meticulous soft tissue handling, component positioning and balance, and wound closure with great attention to prevent infection are the most important aspects of the procedure. When patients ask me about my approach, my response is that I emphasize gentle, soft tissue handling that preserves rather than cuts or traumatizes muscle. If any of these might be compromised due to a concern about the size of the incision, I stress that the focus of the procedure is on accomplishing all of the surgical goals below the skin surface, as that is what will determine a successful implant, recovery and working prosthesis.
That being said, an incision should be as small as possible but still allow for perfect placement of the components, balancing of the soft tissues and recreation of proper leg length. The incision should not be made so small that the surgeon is struggling and the tissues are torn and traumatized. I see patients recover much more quickly when the tissues are treated gently. Component positioning, perfectly aligned prostheses and proper leg length — all of which improve longevity — cannot be sacrificed to a smaller incision. Hip and knee replacement surgery is performed to relieve pain and restore quality of life, not to make smaller incisions work merely because of size and appearance.
My best advice is to choose a surgeon based on reputation, experience and a mutual sense of trust. While it is important to discuss all of the new procedures and technologies available, ultimately you need to know that your surgeon will choose the best course of treatment and surgical procedure that is right for you.