By David P. Hughes, M.D.

Musculoskeletal conditions, including injuries to the bones,
joints, muscles, ligaments or tendons, and problems relating
to arthritis and osteoporosis are the leading cause of doctor visits, exceeding all other medical problems. In 1996, 6.5 million people underwent musculoskeletal procedures, and in 2002,
70 million (1 in 3) adults had arthritis or chronic joint symptoms. Presently, almost 3 million people have surgical procedures
on an inpatient basis.

MIS is a technique where the surgeon performs a procedure
that disturbs the least amount of tissue in the body through
the use of new technology, new procedures, and new surgical approaches. This results in smaller surgical incisions, which in turn results in shortened recovery time.

Building on the arthroscopic technology developed in the late 1960s, MIS has recently come to total joint replacement. When one considers that in 1995 the total costs, including medical care and loss of productivity, exceeded $82 billion, anything that decreases impairment and recovery time would not only be beneficial to the patient but also to society itself.

In hip replacement surgery, an incision is made along the side
of the hip and a large incision is made through the muscles that keep the pelvis from rocking while one walks. The length of recovery is related to how quickly the muscles that have been cut can heal and function in their normal way. In minimally invasive surgery, the object is to disturb the muscles and tendons as little as possible. There are three different ways of doing MIS hip surgery: the anterior approach, the posterior approach, and the anterior/posterior approach where two incisions are made. The single-incision approaches have limitations and often cannot be used because of patient size and/or the amount of deformity of the hip joint. The two-incision procedure benefits those patients who are at risk to develop bone deposits around the new hip. With conventional incisions, precautions sometimes need to be taken to prevent this extra bone growth. In MIS, this complication is unlikely to occur.

In knee replacement surgery, the old technique involves a
larger skin incision and the splitting of the quadriceps tendon
two to three inches proximally at the top of the kneecap. The
MIS technique splits the muscle fibers of the muscle attached
to the inside of the kneecap and this allows for the skin incision to end at the top of the kneecap. Because of the small opening, special instruments were designed to complete the surgery.
Not all people with knee arthritis are candidates for this surgery. People with a lot of bone deformity or stiffness secondary to arthritis may not be candidates for MIS. Some examples are patients with exceptionally stiff knees or severe “knock-knees” deformity. By not having the quadriceps tendon cut, patients
can regain control of the muscles quicker and this should result
in a shorter overall recovery time.

Recovery from MIS surgery in the hip is generally less painful than the regular method. Unfortunately, MIS of the knee does
not necessarily result in less pain during the recovery period.

If faced with surgery, ask your physician about MIS.