Comments on Bonutti PM et al.: Minimally invasive total knee arthroplasty using the contralateral knee as a control group: a case-control study

Abstract

We thank Dr. Hernandez-Vaquero for his constructive comments concerning our article “Minimally invasive total knee arthroplasty using the contralateral knee as a control group: a case-control study” [1]. We agree that these results were obtained by a surgeon who has tremendous experience, and that there can be a large learning curve with this technique. However, for those interested, we advocate an evolutionary, gradual approach to learning minimally invasive surgical (MIS) techniques. One can always start with certain techniques, such as avoiding patellar eversion and various less invasive arthrotomies, with the knowledge that they can be extensile in nature. As the surgeon gains experience, he or she can work toward full minimally invasive techniques. Certainly, much of the literature that these reviewers cite show at least equivalent results for the minimally invasive surgery techniques after the learning curve is mastered. Additionally, the results of our study suggest that there may be lasting benefits in terms of increased quadriceps strength at one year postoperatively in the hands of an experienced MIS surgeon. The choice of technique obviously sometimes becomes a surgeon’s or a patient’s preference, keeping in mind the training, experience level, and case load of the surgeon. We are convinced that some of the advantages of MIS techniques are not only short term. It will be necessary to conduct further prospective, randomised studies to better elucidate the exact nature of these advantages.