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Letter to the Editor: Mini-incision Total Knee Arthroplasty can Increase Risk of Component Malalignment

Rodríguez, Hugo, A

Clinical Orthopaedics and Related Research: August 2006 - Volume 449 - Issue - p 320
doi: 10.1097/01.blo.0000229283.37862.ea
SECTION III: REGULAR AND SPECIAL FEATURES: Letters to the Editor
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Fundacion Hospital San Carlos Bogota, Colombia, South America

To the Editor:

I read with interest the article “Mini-Incision Total Knee Arthroplasty Can Increase Risk of Component Mal-alignment”1 published in November 2005 and wished to provide some comments.

Several studies document minimally invasive knee surgery provides better results and similar radiographic alignment compared with the standard technique.2-4 However, the philosophy of minimally invasive surgery is not based only on a small incision. Additional requirements include a quadriceps-sparing approach, lack of patellar eversion, avoidance of joint dislocation, and the use of specialized instruments. If these criteria are fulfilled, there is a high probability of achieving good results.

Dalury and Dennis reported no difference in range of motion between the two techniques but an increased risk of component malalignment. However, after reading the article carefully, it seemed the only requirement used for the minimally invasive technique was a small incision. In their technique, the authors disrupted the extensor mechanism, everted the patella, dislocated the joint, and used standard instruments. I think the conclusions are invalid because their technique did not fulfill the requirements of minimally invasive surgery. Rather, it was a standard surgery performed through a smaller incision.

Hugo A. Rodríguez, MD

Fundacion Hospital San Carlos Bogota, Colombia, South America

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References

1. Dalury D, Dennis D. Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res. 2005;440:77-81.
2. Hass S, Cook S, Beksac B. Minimally invasive total knee replacement through a mini midvastus approach. Clin Orthop Relat Res. 2004;428:68-73.
3. Laskin R, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC, Pavlov H, Petersen M. Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res. 2004;428:78-81.
4. Tenholder M, Clarke H, Scuderi G. Minimal-incision total knee arthroplasty: the early clinical experience. Clin Orthop Relat Res. 2005;440:67-76.
© 2006 Lippincott Williams & Wilkins, Inc.