Notas / Notes - Active Congress.......

JUEVES / THURSDAY
136
15.30 - 17.45 h
CADERA / HIP
PTR, MIS y Navegación / TKA, MIS and Navigation
Modereador: Aaron Rosenberg
NAVIGATION IN TKA. PRINCIPLES
Francisco Maculé
Hospital Clínic de Barcelona,
Barcelona (Spain)
THE ROLE OF COMPUTER ASSISTED
SURGERY IN TRAINING SURGEONS TO
PERFORM TKA
S. David Stulberg
Northwestern University Feinberg School of Medicine
Chicago, Illinois (USA)
SELECTING THE BEST APPROACH
FOR MIS TKA
Peter M. Bonutti, MD
Bonutti Clinic. Effingham, Illinois (USA)
MIS TKA has been defined primarily based on the Quadriceps
exposure: 1) Mini-Midvastus (VMO Snip) 2) Modified Median
Parapatellar (“Quad Saving”); 3) Mini-Subvastus; 4) Modified
Mini-Subvastus 5) Direct Lateral. All incorporate the principles
of: 1) reduced incision; 2) quadriceps sparing approach; 3)
downsized instrumentation; 4) in situ bone cuts.
We retrospectively evaluated our experience with over 2000
MIS TKA quad approaches to identify the advantages and
disadvantages of each of these approaches.
The Mini-Midvastus (VMO snip) is a straight forward extensile
approach which can be used on the majority of patients regardless
of age, weight or deformity. The Modified Median Parapatellar
(Quad Saving) is technically demanding and requires
high patient preselection. The approach requires osteotomy
of the patella first, then the distal femur. Instrumentation,
especially for patella and distal femoral cut can be difficult and
accuracy of the cuts has been questioned. The Mini-Subvastus
is more difficult for anterior femur exposure. It can be quite
challenging in well-muscled males or in patients with patella
baja. The Modified Mini-Subvastus allows better exposure to
the anterior femur. It avoids any questions of denervation of
the VMO muscle and is extensile. Finally, the Direct Lateral
Approach is the most complex. It may be most cosmetic
approach but instrumentation requires Computer Navigation
and a downsized tibial keel for accuracy. There is a higher
complication rate with a significant learning curve.
Overall, MIS TKA is challenging and requires an evolutionary
approach. Mini-Midvastus (VMO snip) can be a universal
approach. The Mini-Subvastus approach is theoretically appealing,
but exposure is technically challenging. The Modified
Mini-Subvastus approach requires a learning curve but can
be a universal approach. The “Quad Saving” requires significant
patient preselection and there are issues of accuracy of
the bone cuts and higher risk for complication. The Direct Lateral
approach appears to be the most difficult and has the
highest potential for complications. Overall, we recommend
an evolutionary approach to MIS TKA. The Mini-Midvastus
and the Modified Mini-Subvastus can be techniques which
can be applied to most patients and are techniques knee
arthroplasty surgeons can use.
MIS KNEE. A SOFT TISSUE OPERATION?
Hendrik P. Delport
Head department of Orthopaedics AZ Nikolaas
Hospital St Niklaas. Belgium
TKA is one of the most beneficial procedures we have today.
Long-term results have also been outstanding. But performing
a TKA using less than traditional visualization presents us
with new problems.
The hype of MIS has resulted in the observation that most
surgeons have reduced their incisions to smaller ones. The
only way to avoid pitfalls is to know where they lie. Injuries to
the popliteal vessels, the patellar tendon and the medial
collateral ligament are catastrophic.
Failure in alignment and position of the components is always
visible on x-rays. Other non visible anatomic structures (nerves,vessels,
ligaments,etc.) are at risk during the procedure
and should be respected.
Damaging the cutaneous nerves of the knee region can eventually
lead to neurinoma formation. This not only gives raise