DOES SKIN LENGTH MATTER IN MINIMAL INVASIVE TOTAL KNEE ARTHROPLASTY ?

Abstract

Introduction: The aim of this study was to analyze the clinical importance of one single factor, the length of the skin incision in minimal invasive total knee arthroplasty.

Materials & methods: This was a prospective randomized single surgeon study. All patients were randomized for sex, age, diagnosis and BMI. In 40 consecutive knees, primary total knee arthroplasty was performed with minimal invasive instruments, through a 12 cm skin incision and a mini-midvastus approach. After cementation of the components and closure of the arthrotomie, half of the patients (20) were randomized (enveloppe technique) to have their skin incision extended from 12 to 20 cm.

The following data were assembled by a skin incision blinded study nurse: VAS, use of morphine pump, range of motion, straight leg raising, time to independent ambulation, time to discharge, wound problems and complications up to 6 weeks postoperative.

Results: For all these studied parameters there was no statistical significant difference between both study groups.

Conclusion: With this prospective randomized study we were able to analyze the functional effect of a larger skin incision in minimal invasive (MI) total knee arthroplasty and the placebo effect for the patient to see a smaller scar. We can conclude that the exact length of the skin incision is a non issue in MI total knee arthroplasty. Patients benefits are obtained by less soft tissue damage, the avoidance of patellofemoral and tibiofemoral dislocation and optimal patient management. We even believe that performing MI total knee arthroplasty through a comfortable incision could be advantageous. Shorter operating time, less skin bruising and avoidance of skin – implant contact can be obtained.