Minimally invasive total knee arthroplasty is growing in popularity. It appears to reduce blood loss, reduce hospital stay, improve post-operative quadriceps function and shortens post-operative recovery. We show our experience of minimally invasive TKA with a computer navigation system. Forty patients who underwent MICATKA were compared with forty patients having conventional CATKA. Component positioning was assessed radiographically with AP long leg standing views. Knee Society Scores, length of stay and recovery of straight leg raise was also recorded pre-operatively and at 6, 12, 18 and 24 months. Pre-operative Knee Society Scores showed no significant difference between the two groups. Post operatively the mean femoral component alignment was 89.7 degrees for MICATKA and 90.2 for CATKA. The mean tibial component alignment was 89.7 degrees for both. Knees society scores at 6, 12, 18 and 24 months were statistically better in the MICATKA (p<
000.1). However the mean difference in Knee Society Scores had fallen. Straight leg raise was achieved by day one in 93% of the MICATKA compared to only 30% of the CATKA. Length of stay for MICATKA was a mean of 3.25 days with CATKA a mean of 6 days. MICATKA is a safe procedure with reproducible results. Alignment is equivalent to CATKA. It gives statistically significant improvement in Knee Society Scores compared to the open procedure. The length of stay and time to straight leg raise is also reduced. At a minimum of 2 years follow-up we have seen no revisions and no evidence of radiographic loosening. A randomised multi centre trial is under way and early results are awaited.
Traditionally, immobilisation following achilles tendon rupture has been for 10 to 12 weeks. We have previously published a series of 71 consecutive repairs with no re-ruptures, using a lateral surgical approach. The latter part of this cohort were immobilised for six weeks instead of 12, with early weight bearing. The lack of any re-ruptures encouraged us to pursue the accelerated rehabilitation. This study documents a further 34 cases followed prospectively for 6–24 months (mean 15.9 months). All were repaired with a single Kessler-type suture using loop PDS, through a lateral approach. Patients were partial weight-bearing immediately in an Aircast boot with three cork heel wedges. At two-weekly intervals the wedges were reduced, and the boot abandoned after six weeks. There have been no re-ruptures. Thirty of the 34 patients returned to pre-injury activity levels. All patients were satisfied or very satisfied with the immobilisation device and the accelerated rehabilitation regime. Cost savings were also made through use of a single removable orthosis rather than sequential casts. We advocate this regimen of careful operative achilles tendon repair and accelerated weight bearing rehabilitation with a removable orthosis.
Traditionally, immobilisation following Achilles tendon rupture has been for 10 to 12 weeks. We have previously published a series of 71 consecutive repairs with no re-ruptures, using a lateral surgical approach. The latter part of this cohort were immobilised for six weeks instead of 12, with early weight bearing. The lack of any re-ruptures encouraged us to persue the accelerated rehabilitation. This study documents a further 34 cases followed prospectively for 6–24 months (mean 15.9 months). All were repaired with a single Kessler-type suture using loop PDS, through a lateral approach. Patients were partial weight-bearing immediately in an Aircast boot with three cork heel wedges. At two-weekly intervals the wedges were reduced, and the boot abandoned after six weeks. There have been no re-ruptures. Thirty of the 34 patients returned to pre-injury activity levels. All patients were satisfied or very satisfied with the immobilisation device and the accelerated rehabilitation regime. Costs savings were also made through use of a single removable orthosis rather than sequential casts. We advocate this regimen of careful operative achilles tendon repair and accelerated weight bearing rehabilitation with a removable orthosis.
