Knee Surgery Options: Traditional vs. Minimally Invasive

Knee joint surgery-related issues?

Hello, doctor.
My family member underwent traditional total knee replacement surgery over a month ago and has been experiencing significant soreness and discomfort postoperatively.
We are concerned about the possibility of surgical failure.
However, during the follow-up appointment, the doctor mentioned that the recovery was progressing well.
Later, we learned that this doctor also performs a minimally invasive knee replacement surgery, which has a quicker recovery time and better outcomes.
My family member expressed that if we had known earlier, we would have requested the minimally invasive procedure to avoid enduring the ongoing pain.

Initially, when the traditional surgery was performed, the doctor did not proactively inform us about the option of minimally invasive surgery.
We only discovered this option after seeing reports about the doctor’s minimally invasive procedures.
My family member was hesitant to ask the doctor why this option was not mentioned, fearing that it might upset the doctor and be perceived as questioning his expertise.

We would like to understand why, if minimally invasive knee replacement surgery is superior to traditional surgery, the doctor did not inform us of this option and instead proceeded with the traditional surgery.
Is it common for doctors to perform traditional surgeries without disclosing better alternatives? Additionally, is minimally invasive knee replacement surgery always better than traditional total knee arthroplasty?
My family member has been uncomfortable since the surgery, and we have seen other patients of the same doctor who experienced postoperative pain lasting up to a year.
We regret not asking more questions before proceeding with the surgery.
During follow-up visits, we have expressed concerns about the postoperative discomfort (worried about suboptimal surgical outcomes that are not immediately apparent), but each time we ask the doctor, he reassures us that the X-rays look fine, making us feel that our concerns are being dismissed.
We are worried about spending money on surgery and enduring pain without knowing when it will end.
Given this situation, would it be appropriate for us to consider switching to a different doctor?

Cady, 70~79 year old female. Ask Date: 2023/11/14

Dr. Shi Guozheng reply Orthopedics

1.
Currently, most physicians perform total knee arthroplasty using a minimally invasive approach, and they usually explain this to the patients beforehand; communication is essential.

2.
Minimally invasive surgery involves smaller incisions, less muscle dissection, and reduced tissue damage.

3.
The benefits of minimally invasive surgery include faster recovery and less pain.

4.
Of course, the outcomes six months or a year later are similar to those of traditional surgery.

5.
The recovery of soft tissues after knee surgery typically takes about six weeks, with complete recovery taking around two to three months.

6.
However, it varies from person to person; some individuals recover in less than a month, while others may take up to three months.

7.
Post-surgery, rehabilitation is necessary, including bending your knee and performing strength training exercises; this should be done independently, along with medication to manage joint pain.

Reply Date: 2023/11/14

More Info

When considering knee surgery options, particularly between traditional total knee replacement (TKR) and minimally invasive knee replacement, it is essential to understand the differences, benefits, and potential drawbacks of each approach.
Traditional Total Knee Replacement:
Traditional TKR involves a larger incision, typically around 8 to 12 inches long, which allows the surgeon to access the knee joint directly. This method has been the standard for many years and is well-studied, providing reliable outcomes for patients with severe knee arthritis or damage. However, the larger incision can lead to more significant postoperative pain, longer recovery times, and increased risk of complications such as infection or blood clots. Patients may experience swelling and discomfort for an extended period, often several months, as they heal from the surgery.

Minimally Invasive Knee Replacement:
Minimally invasive knee replacement, on the other hand, uses smaller incisions, often around 4 to 6 inches, and may involve specialized instruments that allow the surgeon to perform the procedure with less disruption to surrounding tissues. This approach can lead to less postoperative pain, quicker recovery times, and shorter hospital stays. Patients often report a faster return to daily activities and improved mobility. However, not all patients are candidates for this type of surgery, and the surgeon's experience with minimally invasive techniques can significantly impact the outcome.

Why the Lack of Communication?:
Your concern regarding the lack of information about minimally invasive options from the surgeon is understandable. There are several reasons why a surgeon might not present all available options. Firstly, the decision on which surgical approach to take often depends on the specific condition of the knee, the surgeon's expertise, and the patient's overall health. If the surgeon believes that traditional surgery is the best option based on their assessment, they may not discuss alternatives. Additionally, some surgeons may have more experience with traditional methods and may feel more comfortable recommending them.

It is also important to note that while minimally invasive surgery has its advantages, it is not universally better for every patient. Factors such as the severity of knee damage, the patient's anatomy, and any previous surgeries can influence the decision. In some cases, traditional surgery may be more appropriate to ensure the best possible outcome.

Postoperative Concerns:
Regarding your family member's ongoing discomfort after traditional knee replacement, it is not uncommon for patients to experience pain and stiffness during the recovery process. While some patients recover quickly, others may take longer to heal. If the pain persists or worsens, it is crucial to communicate these concerns with the surgeon. If you feel that your concerns are not being adequately addressed, seeking a second opinion from another orthopedic surgeon could be beneficial. A fresh perspective may provide additional insights into the recovery process or alternative treatment options.

Conclusion:
In summary, both traditional and minimally invasive knee replacement surgeries have their respective advantages and disadvantages. The choice of procedure should be based on a thorough evaluation of the patient's condition, the surgeon's expertise, and a clear discussion of the risks and benefits. If there are ongoing concerns about postoperative pain or the adequacy of care, it is entirely reasonable to seek a second opinion. Open communication with healthcare providers is essential for ensuring that patients receive the best possible care tailored to their individual needs.

Similar Q&A

Understanding Knee Injury Treatments: Surgery vs. Alternative Options

Four months ago, after exercising, I suddenly found it difficult to squat down the next day. My right knee was somewhat swollen but not painful. A few days later, I visited an orthopedic doctor who drained the excess fluid. After the drainage, I was able to squat down, but curren...

Dr. Shi Guozheng reply Orthopedics
The MRI report did not indicate a meniscus tear, so conservative treatment can be considered. If there is no improvement, we can reassess the situation later.

Understanding Surgical Treatment Options for Patellar Malalignment

Hello, I have seen your previous response regarding "patellar chondromalacia." According to my physician's diagnosis, I have congenital valgus deformity of the patella (and both legs are affected). I have also undergone rehabilitation, but there hasn't been mu...

Dr. Shi Qiming reply Orthopedics
Hello: Traditionally, a 3.95 cm incision is made on the lateral side of the knee, followed by a surgical incision of the lateral knee fascia. The potential complications include a 5% risk of knee hematoma, knee weakness, wound infection, among others. Thank you!

Understanding Knee Scar Surgery: Costs, Risks, and Age Considerations

What type of surgical procedure is used for wounds from a fall (on the knee)? What is the approximate cost for a one-centimeter wound? Are there any side effects of cosmetic surgery at a young age?

Dr. Lu Daokuan reply Plastic Surgery
The knee is a joint that is easily flexed, and generally, scars in areas that are prone to flexion are not suitable for surgery. Please consult with an orthopedic outpatient clinic.

ACL Avulsion Fracture: Traditional vs. Minimally Invasive Surgery Options

Hello, two weeks ago I had a car accident, and X-rays and MRI confirmed an ACL sprain with a fracture. I would like to inquire about the recommendations for traditional surgery versus minimally invasive surgery. Additionally, how long after the surgery can I resume normal activit...

Dr. Li Yongheng reply Orthopedics
Hello, in the case of a non-displaced anterior cruciate ligament (ACL) avulsion fracture, it can be treated with a cast without the need for surgery. If the fracture is displaced, minimally invasive arthroscopic surgery is recommended. Generally, a brace is required for 4-6 weeks...