Minimally Invasive Subvastus Total Knee Replacement

Total Knee replacement is a reliable operation to relieve pain and suffering due to disabling arthritis of the knee. However, many patients have reservations due to its prolonged recovery and need for physiotherapy. Inability to squat and kneel after the operation, which is particularly important to Indian patients also acts as deterrent. Techniques that have been employed by me, for the first time in India, have drastically cut the recovery rates down. Many patients after my MI TKR have been able to walk without even holding a walking stick on the third day post surgery. The need for physiotherapy also has become much less. With the superior quality of joints available, activities such as kneeling and squatting are possible in selected patients. These benefits are enjoyed due to advanced surgical techniques that involve a minimal incision on the front of the knee. This cut is typically less than 4 inches. Former incision lengths were around 9 to 12 inches.

Surgical approach

In subvastus MITKR no cut is made on the underlying thigh muscle called the quadriceps. Instead the joint is approached below the muscle.

This has huge advantages such as not weakening the thigh muscles at all and this is the reason that the patients are able to walk even without holding on to any walking aids almost immediately after the operation. The earlier approach involved cutting the quadriceps. If the quadriceps is cut, the patients typically need walking aids for 3 to 6 weeks to allow this cut to heal. Moreover, cutting the quadriceps causes more pain and delays the recovery from the operation.

Mini Incision
The instruments to implant the joint and the surgical techniques have been suitably modified so that the new knee joint can be implanted accurately through an incision less than 4 inches. This has advantages, as the lesser the cut on the skin, lesser is the pain and earlier the recovery.

Reduced pain during recovery
The mini TKR through the subvastus approach coupled with advanced postoperative analgesia reduces the pain associated with recovery after the operation. This allows the patients to bend the knee and walk freely very early in the post-operative period.

Full bend of the knee
The ability to achieve full bend of the knee requires the joint to be implanted perfectly.
Care is taken intra-operatively to ensure that the joint is bending fully on the operation table. This allows mobilization of the knee to begin immediately after the operation and to eventually achieve full flexion. The high flex and mobile joints that are available help in achieving this aim.

Subvastus approach
Traditionally knee replacement surgery would involve around a 9 to 10 inch cut in front of the knee. The muscle of the thigh ( Quadriceps) would be cut and then the knee joint would be reached. Recovery would take longer and be painful as the muscle needed time to heal. In the subvastus approach , no muscle is cut. The knee is entered below and beneath this muscle.( see the diagrams later ) Hence the recovery is very quick. Moreover, due to better instrumentation, the operation can be carried out through a much smaller incision almost half of the previous length of the incision. This is called Minimally Invasive TKR or MI – TKR through a subvastus approach. Dr. Premkumar Viswanath is the pioneer surgeon in India who is employing these methods for his patients.

New Joints
New knee joints that are available would allow full function and mobility when implanted properly. This is the reason that Dr. Premkumar Viswanath has been getting these kind of results routinely in numerous patients that are treated by this method. This is especially relevant to us in the Indian setting due to our habits and customs.