MIS of the hip and knee: a clinical perspective

Abstract

The Journal of Bone and Joint Surgery. British volumeVol. 87-B, No. 7 Book ReviewsFree AccessMIS of the hip and knee: a clinical perspective Edited by G. R. Scuderi and A. J. Tria Jr. Pp 204. New York: Springer-Verlag, 2004. ISBN: 0-38740-353-1. £100.00.A. RossA. RossSearch for more papers by this authorPublished Online:1 Jul 2005https://doi.org/10.1302/0301-620X.87B7.16656AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail The premonitory statement, “This is a new and exciting period in orthopaedic surgery”, seems to convey the breathless excitement of the enthusiast rather than the considered wisdom of the experienced practitioner. But despite the somewhat unpropitious start, this volume is not short of wisdom and the authors have been selected on the basis of their wide experience of lower limb joint replacement, rather than their unconditional advocacy of minimally-invasive techniques.The difference between the two approaches, wide or narrow, is nowhere more evident than in the two chapters concerning total hip replacement. The first by Berger, addresses the two-incision approach to the hip which he has been instrumental in developing. I confess to finding this approach irrational, as do others, but he describes it clearly enough. He advocates the use of a number of new instruments which have been developed “to facilitate exposure and component placement”. At the risk of sounding a traditionalist, I would suggest that nothing facilitates exposure and component placement like an adequate incision. The second chapter, by Sculco and Jordan, takes a much more balanced approach to the subject and, in fact, presents an excellent reasoned summary of the whole topic, reflecting the importance of the conduct of the operation over the length of incision. Short incisions are nothing new, merely the product of experience and thought.The organisation of this book reflects the speed at which minimally-invasive approaches are being applied in the various anatomical locations. Consequently, there are only two chapters on hip arthroplasty and two on total knee arthroplasty, while there are six on unicondylar knee replacement. These six chapters give a good overview of the current state of this procedure. Various types of prosthesis and instrumentation are described in detail. Whether there is any genuinely new information in these chapters is open to debate. A mild sceptic might reflect that a unicondylar knee replacement is markedly smaller than the other two implants and therefore lends itself to be implanted through a shorter incision.In the chapters on total knee replacement, an admirable caution is expressed. The approaches described and the views expressed are very comparable with those enunciated in Sculco and Jordan’s chapter on total hip replacement. The incision is shorter, but the difficulties of carrying out this procedure through the shorter incision are not underestimated and the results are expressed cautiously. This is entirely appropriate.The use of the term ‘minimally invasive’ would probably not impress the Advertising Standards Authority. While the incision is short, the procedure performed through it is just as extensive (or minimal) as with an open technique. ‘Minimal incision’ is to be preferred, particularly when explaining the procedure to a patient. The editors justify these minimally-invasive techniques as an attempt to “reduce the amount of intraoperative trauma and expedite the path to recovery”. They express the view that minimally-invasive surgery leads to a shorter hospital stay and a quicker recovery. They speculate that these procedures may eventually be performed on an outpatient basis, with an earlier return to daily activities and work. While these are admirable aims, they are not universally supported by the scientific evidence. Consequently, this book belongs only in the library for technical reference, and on the shelves of experienced lower limb arthroplasty surgeons who have not already reduced the length of their incisions with the passage of time. The many typographical errors are irritating.FiguresReferencesRelatedDetails Vol. 87-B, No. 7 Metrics Downloaded 107 times History Published online 1 July 2005 Published in print 1 July 2005 InformationCopyright © 2005, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download