Orthopedic surgeons at Rush University Medical Center found that 96 percent of patients who had minimally invasive total knee replacement surgery were able to go home the same day, without complications-many walking out unassisted or with a cane. These results were published in the October issue of the Journal of Arthroplasty.

Lead author surgeon Dr. Richard A. Berger says it’s not just the surgeon’s skills and techniques that help patients avoid a hospital stay. 

“It’s a comprehensive management approach that helps the patient avoid an overnight stay. It’s optimal sequencing and timing of interventions by the nursing, physical therapy, anesthesia surgical team; it’s a team approach of equally weighted preoperative, intraoperative, and postoperative care.”

The MIS Quad-Sparing total knee procedure is performed through one small three- to four- inch incision instead of a large, eight- to 12-inch incision. This approach has the potential for dramatically reducing pain by sparing muscles and tendons that historically have been cut during standard TKA surgery. "Using new tools and minimally invasive surgical techniques, we avoid cutting through the quadriceps tendon and muscles and replace the damaged knee through a three- to four-inch incision, rather than the standard eight- to 12-inch incision down the front of the knee,” says Berger.

First, the patients meet with the surgeon to evaluate whether the patient would be appropriate for the minimally invasive knee replacement. Next, patients who will receive a minimally invasive knee replacement meet with the physical therapist and nurse prior to surgery. “They attend a class led by with a nurse where potential surgical complications and postoperative care are discussed. Patients spend an hour learning about the surgery, asking questions about pain, recovery and surgery. We reassure patients that their pain will be controlled, that they will be carefully monitored for the occurrence of complications or delayed recovery due to early discharge, and explain how will be able to move around independently after surgery.

After class with the nurse, patients have a physical therapy session for instruction in gait training with crutches and a cane.  An internist also evaluates the patients. Lastly, the hospital discharge planner calls the patient at home before surgery to make sure arrangements have been made to have someone take the patient home after surgery.”

The 50 study patients (20 female, 30 males) in the study had surgery between August 2003 and August 2004. The average age was 68 years old, average weight of 203 lbs. with a body mass index of 29.2.  Forty-eight of the patients had osteoarthritis. Each patient was the first surgical case of the day.

Berger, who pioneered and perfected minimally invasive outpatient surgery in 2003, explains his technique for total knee arthroscopy (TKA) does not cut the quadriceps muscle and quadriceps tendon.

“The only incision is from the joint line to the superior pole of the patella. The quadriceps tendon is not cut or split.  The knee is not dislocated; instead, in situ cuts are made.   Because there is less cutting of muscle and less blood loss, less anesthesia is required and the recovery time is greatly reduced. The patient is out of surgery in less than two hours.”

After surgery, patients see an occupational and physical therapist. Patients must be able to independently get in and out of bed, rise from a chair, walk 100 feet, and walk up and down a full flight of stairs before they can leave the hospital. If the patient feels comfortable and would like to go home, they are released with pain medication.

Patients receive home physical therapy until they can drive; then, outpatient physical therapy is started. Patients were evaluated clinically and radiographically in the office at one week, two weeks, six weeks, and three months.

Berger says this study demonstrates that, in these selected patients, “outpatient total knee replacement through arthroscopy was safe with no short-term readmission or complications related to early discharge. New clinical guidelines, including improvements in anesthetic techniques, postoperative pain management, and rehabilitation protocols, will make performing outpatient total knee arthroscopy a realistic goal. This comprehensive pathway may make it possible for this minimally invasive knee surgery to be done as an outpatient in specialized surgicenters in the future.”

Interested patients should call (312) 432-2519.