MINIMALLY INVASIVE SURGERY FOR UNICOMPARTMENTAL KNEE ARTHROPLASTY BY TRANSVERSE INCISION

Abstract

Minimally invasive surgery (MIS) for unicompartmental knee arthroplasty (UKA) has become increasingly popular. However, wound problems may be encountered with longitudinal skin incisions. This probably occurs because the skin is under excessively high tension during MIS. We have been using transverse incisions for MIS-UKA. We describe the surgical technique and an experimental study for assessing blood flow in the skin around the knee.

A 5–7 cm transverse skin incision was made from the medial edge of the patella at the level of 1–2 cm proximal to the joint line. The capsule was incised along the medial parapatellar up to the proximal two-thirds of the patella, and a few cm were also cut along the distal end of the vastus medialis. Because skin on the anterior aspect of the knee is more flexible in the longitudinal direction, exposure is easy even with a small incision.

Experimental study: We measured the direction of blood flow on the anterior aspect of the knee using laser flowmetry. Nine normal subjects were examined. A probe was attached to the skin on the medial parapatellar region, and two 7 cm long parallel depressors were applied bilaterally on the sides of the probe. The depressors were placed longitudinally or transversely under 30N of compression force, and then blood flow was recorded.

Blood flow was markedly increased due to congestion when the depressor was placed longitudinally. On the contrary, changes in blood flow were significantly lower when the depressor was placed transversely.

Transverse incision can lead to better exposure and permit an smaller incision. Moreover, transverse incisions are less invasive to the skin’s circulation and leave less distinctive scars than longitudinal incisions.