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Quad Sparing Robotic Knee Replacement Surgery

Knee replacement is a surgical procedure that is designed to eliminate pain and improve function by eliminating knee arthritis. Surgeons have been performing knee replacement surgery for over 30 years with satisfactory results. As technology continues to evolve surgeons have sought new techniques for minimizing soft tissue disruption to decrease pain from surgery and improve results. Recently there have been two ways to perform knee replacement surgery, traditional knee replacement and minimally invasive knee replacement.

Traditional Total Knee Replacement

This is the way I was initially trained at Mayo Clinic. It involves a roughly 8-inch incision over the front of the knee. Below the incision, the knee is visualized by cutting through the quadriceps tendon. This approach allows excellent visualization and has shown excellent long term results after patients have recovered.

Minimally Invasive Total Knee Replacement

This is a relatively new technique that was designed to allow patients a faster recovery time. The procedure involves a smaller incision (3-4 inches) and does not cut the quadriceps tendon. This is sometimes referred to as a quadriceps sparing approach because the tendon is not cut during the operation. Theoretically this allows patients to have earlier return of muscle power to the knee and a faster recovery.

For several years this technique became popular, however we started seeing problems. Because surgeons were putting implants in through a small window we started to see the knee replacements were being put in the patient incorrectly due to lack of visualization. We also started to see wound healing problems because the skin was getting stretched too far. This led the majority of knee replacement surgeon to abandon minimally invasive techniques.

Minimally Invasive Robotic Knee Replacement

Over the past year we now have robotic total knee replacement available. This technology allows us to plan the exact position of the knee replacement on a computer prior to surgery. I have been using this technology for partial knee replacements since 2011, and have been extremely impressed with the precision and reproducibility of the robot in this setting.

Since the robot relies on a preoperative CT scan to place the knee replacement, the surgeon can place the components very accurately. Additionally, the robot doesn’t have eyeballs. The robot uses sophisticate arrays that tell it where the knee is three dimensionally. This allows me to place the knee replacement without having to open the knee in a traditional manner. I am now able to avoid cutting the quadriceps tendon to perform the knee replacement, because I use the robot as my “eyeballs” for putting the knee replacement in.

The advantages of this technique for my patients:

  • More rapid return to function. For busy patients that want to get back to work or life sooner the quadriceps tendon isn’t cut during this approach.
  • Smaller incision. Although many patients aren’t concerned with the cosmetic impact of knee replacement the incision is much shorter than traditional knee replacement
  • Decreased postoperative pain. Several studies have documented less pain following minimally invasive knee replacement.
  • High quality implants. The robot now allows me to perform the surgery using well-tested implants without any “homemade” cutting guides for minimally invasive surgery.