Minimally invasive total knee arthroplasty: a 10-feature evolutionary approach.

There should not be a revolution to MIS-TKA but rather an evolutionary approach. This includes progressively downsizing incisions and causing less damage to the quadriceps mechanism. Previously,there was an extensive open exposure prolonged patella eversion and dislocation of the tibio-femoral joint. This should be evolved into a VMO muscle split with patella subluxation, retraction but not dislocation, and no gross dislocation of the tibio-femoral joint. Although the present MIS-TKA technique can be difficult and time-consuming, the resulting patient benefits should outweigh the extra effort required. In the future, we may use bone cuts and implantation with computer navigation. Each advance, however, will require new techniques, instrumentation, implants, and careful clinical studies. Caution should be taken by surgeons to avoid revolutionary approaches with existing implants, because they harbor a risk of catastrophic failure.