How the Surgical Exposure Facilitates More Rapid Recovery after TKA

    Dr. Richard Berger discusses the role of minimally invasive techniques in a rapid recovery protocol that includes patient education and rehabilitation and multimodal pain management.

    The size of the incision isn’t what makes a minimally invasive approach to total knee arthroplasty – it’s what the surgeon does under the skin that matters.

    Speaking at ICJR’s Winter Hip & Knee Course, Richard A. Berger, MD, from Rush University Medical Center, Chicago, Illinois, shared his thoughts on techniques for exposing the knee and minimizing soft tissue injury that will help patients recover more quickly and reduce their length of stay in the hospital.

    Dr. Berger’s presentation was part of a session at the Winter Hip & Knee Course that addressed issues surrounding rapid recovery and outpatient arthroplasty. As he noted, minimally invasive techniques are important, but to truly help patients, they need to be part of a protocol that emphasizes patient education and rehabilitation and multimodal pain management.

    Dr. Berger identified 3 exposures options that are appropriate for facilitating rapid recovery after total knee arthroplasty, from most to least exposure:

    • Mini-subvastus
    • Mini-midvastus
    • Capsular only

    The exposure the surgeon selects will depend on patient factors, implant factors, and instrument availability. For example, surgeons will need more exposure with patients who are heavy, muscular, and have large bones and rigid tissue.

    Dr. Berger emphasized that whatever exposure a surgeon uses will work well in facilitating rapid recovery if he or she minimizes soft tissue injury in the process. His tips include:

    • Minimize the number of retractors used; they should gently hold back the tissue, not pull on and avulse tissues that have not been cut
    • Perform the procedure in as much extension is possible, at least until all cuts have been made and the tissue is no longer in tension
    • Minimize eversion of the patella under tension
    • Be prepared to see only what you need to see, when you need to see it; wide exposure is a luxury for which the patient will pay
    • Avoid dislocation of the knee

    Dr. Berger’s presentation from the Winter Hip & Knee Course can be viewed here.