Purpose: Authors introduce short term results, hazards and solutions of 52 minimally invasive total knee replacement performed in their institute. Aspects of minimally invasive and minimalised exposures are detailed with differences in indication .

Methods: Starting in June 2004 52 minimally invasive total knee replacements were performed in authors institute. The technique is quadriceps sparing, the implants are placed in through a medial parapatellar MIS incision. Types of vastus medialis insertion are crucial in indication of MIS or minimalised total knee. Preparation of the surfaces needs careful preparation, precise instrumentation and skill. Following patellar resection alignment, ligament balance should be treated as important and accurate as with other techniques. No muscles and tendons are detached Neurovascular hazards, complications, difficulties with solutions are introduced. Indication is determined by pathoanatomy and weight of the patient. Malalignment shouldn’t exceed 10–15 degrees. Flexion contracture more than 10 degrees is contraindication of the technique.

Depending on the type of vastus insertion midvastus approach was used with good results in 8 cases .

Results: The operation performed on properly selected patients results in a good implantation with appropriate ligament balance and stability. Average flexion was 74 degrees in the first two post op days. Post operative pain was significantly reduced. Hospital stay was 3,1 days. There was no infection. Conversion to normal exposure was done in 3 cases. In 8 cases midvastus approach was preferred because of anatomy.

Conclusions: Minimally invasive total knee replacement is technically more demanding, requiring adequate training and knowledge. Appropriate indication is inevitable. Hospital stay and rehabilitation time is reduced also resulting in economic benefit, though never compromising good result of TKR.