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Minimally Invasive Total Knee Replacement Surgery

Minimally Invasive Total Knee Replacement Surgery

What is Minimally Invasive Total Knee Replacement Surgery?

Total knee replacement is a common orthopedic procedure that is used to replace the damaged or worn surfaces of the knee. Replacing these surfaces with an implant or "prosthesis" will relieve pain and increase mobility, allowing you to return to your normal, everyday activities.

One of the most important orthopedic surgical advances of the twentieth century, knee replacement surgery was first performed in 1968. Improvements in surgical materials and techniques since then have greatly increased its effectiveness. Approximately 300,000 knee replacements are performed each year in the United States alone, making it one of the most common surgeries worldwide. Over the past decade, however, minimally invasive techniques have been developed and today, there are minimally invasive procedures for both partial and total knee replacements.


Knee Replacement Surgery Preparation

Before your departure your records will be reviewed thoroughly by our orthopedic surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.

After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will also review your hip replacement procedure and answer any questions.

Getting your house ready before your surgery

It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.

  • Remove all your throw rugs or anything on the floor that may cause you to trip.
  • Move phone and electrical cords close to the walls.
  • Add pillows or cushions to the chairs you will be using after surgery to make sure that your hip is above the level of your knees when you are seated. This will lessen the risk of dislocation of your new hip.
  • Arrange to have an elevated toilet seat or support bars fitted to your bathroom before you leave the hospital.
  • Move necessary personal items you need to reach to shelves and tables that are above your waist level. You should not be bending past 90 degrees during rehabilitation.

Preparation for the hospital

Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:

Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:

  • Loose shorts or pants
  • Loose tops or T-shirts
  • Underwear and socks
  • Short robe or pajamas
  • Toiletries
  • Shoes
  • It is vital to bring the right shoes to the hospital. You may want to buy a new pair of shoes so that your walking is not influenced by the wear patterns on your old shoes (inspect the soles of your shoes for these patterns). When deciding what shoes to bring, consider the following:
  • The foot on your operated leg may be swollen after surgery. Bring a shoe that accommodates that increased size. The shoe can be a slip-on or laced.
  • Choose a shoe with a low heel of less than one inch. Gym shoes and walking shoes are fine.
  • Walking aids
  • If you are already using one, leave it at home. We will provide any aids you need upon your discharge from the hospital, for the duration of your stay with us.


During any knee replacement, the damaged cartilage and bone from the surface of the knee is removed, along with some soft tissues. The goal of knee replacement surgery is to provide the patient with a pain-free knee that allows for the return to daily activities and lasts for a long time.

The traditional approach to knee replacement uses a long vertical incision in the center of the knee to view and access the joint. Minimally invasive total knee replacement is a variation of this approach. Minimally invasive knee replacement differs from traditional knee replacement in that it uses an incision that is approximately half as long and fewer muscles are cut and detached. This less-invasive technique endorses the reduction of postoperative pain and speeding recovery.   

     Traditional Knee Replacement:

To perform a traditional knee replacement, the surgeon makes an 8- to 10-inch vertical incision over the front of the knee to expose the joint. The surgeon will then:

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending on the case.
  • Insert a spacer. A plastic spacer is inserted between the metal components to create a smooth gliding surface.

     Minimally Invasive Knee Replacement:

In minimally invasive knee replacement, the surgical procedure is similar, but there is less cutting of the tissue surrounding the knee. The artificial implants used are the same as those used for traditional knee replacement.

Your orthopedic surgeon will remove the damaged cartilage and bone and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee. However, specially designed surgical instruments are used to measure and prepare the femur and tibia and to place the implants properly, endorsing an optimal fit.

Minimally invasive knee replacement is performed through a shorter incision—2-to 3- inches versus 8 to 10 inches for traditional knee replacement. In addition to a shorter incision, the technique used to open the knee is less invasive. In general, techniques used in minimally invasive knee replacement are "quadriceps sparing," meaning they avoid trauma to the quadriceps tendon and muscles in the front of the thigh.

Other minimally invasive technique called "subvastus" makes small incisions in the muscle but is also less invasive than traditional knee replacement. Because the technique used to expose the joint involves less disruption to the muscle, it may lead to less postoperative pain and reduce recovery time.

The procedure itself takes approximately 1-2 hours.

After your total knee replacement surgery, you will be taken to the recovery room for a period of observation. The staff will monitor your blood pressure, heart rate, respiration and body temperature. Special attention will be given to your circulation and sensation in your feet and legs. When you awaken and your condition is stabilized you will be transferred to your room.

Your leg may be positioned in a Continuous Passive Motion (CPM) machine after surgery. While you are in bed, this machine will continuously bend and straighten your leg. The CPM machine keeps your joint from becoming stiff and speeds recovery.

How Long Will the Knee Implant Last?

The longevity of the implant depends on many factors such as the patient’s weight, the patient’s activity level, and the presence or absence of disease in other joints of the lower extremities.

Implants can last ten to fifteen years and even longer. New techniques allow for an implant to be removed and replaced, but our goal is to be able to implant a prosthesis that will last the patient a lifetime without revision.

The Knee Replacement Surgery Advantages

  • A significant improvement in the ability to perform common activities of daily living.
  • A smaller incision allows for less tissue disturbance.
  • Less or no cutting of key muscles and tissues
  • Less pain, decreased recovery time and better motion due to less scar tissue formation.
  • Less risk of infection
  • More than 90% of individuals who undergo total knee replacement experience a dramatic reduction of knee pain.
  • Shorter (or no) hospital stays

Knee Replacement Surgery Results

Results are impressive and gratifying to both the patient and the surgeon. Most patients are pain-free and able to bend their knees from 90° to 100°, resuming daily activities without restriction. The remarkable results of total knee replacement are due to patient determination, the surgeon’s skill, and the bioengineers’ well-designed implants and instruments. However, a total knee replacement procedure will not make you a super-athlete or allow you to do more than you could before you developed knee problems. Activities that you can reasonably expect to be able to do after surgery are:

  • Recreational walking
  • Swimming
  • Golf
  • Driving
  • Light hiking
  • Recreational biking
  • Ballroom dancing
  • Stair climbing

Hospital discharge and home instructions

The hospital stay after minimally invasive surgery is similar in length to the stay after traditional knee replacement surgery, typically ranging from 1 to 4 days. The procedure is also sometimes performed on an outpatient basis.

Progress varies from patient to patient so discharge instructions may vary.

Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and physical therapist and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.



Physical rehabilitation is a critical component of recovery. Your surgeon and physical therapist will provide you with specific exercises to help increase your range of motion and restore your strength.

The estimated rehabilitation/recovery time after MIS partial knee replacement is approximately five weeks for many patients, but it varies.



In general, patients must use support in two hands for about six weeks after surgery while their muscles are rehabilitating. You will be given written instructions for the exercises you will be continuing upon your return home.

Physical Therapy

Following surgery, you will receive physical therapy. Trained professionals will determine the personalized exercise programs for your physical therapy.

Your physical therapist will start you off between parallel bars in preparation for the use of crutches or a walker. These bars allow you to practice walking by supporting part of your body weight with your arms rather than on your surgical leg. A short robe and low-heeled walking shoes are recommended when learning to walk with crutches or a walker.

 As you become more comfortable with walking, your physical therapist may allow you to practice walking on the hospital unit with assistance. Before you go home, your therapist will teach you to climb stairs and to transfer from a bed, chair, and car.

Your physical therapist will design an exercise program to increase the motion and strength of your knee. Range of motion exercises will let your knee move easily from the fully straight position to a 90° bent position.

Your participation is vital. The goal is for you to become as independent in your personal care and daily activities as possible before you return home.