Rapid recovery protocols and minimally invasive surgery help achieve high knee flexion.

Although the primary goal of total knee arthroplasty is to relieve pain, the attainment of high flexion has emerged as an important secondary goal. Clinical pathways are evolving and focus on rapid recovery. The entire perioperative process for the patient and family, including office and hospital procedures, has been streamlined and patients are advised from the initial evaluation they will be able to quickly return to activities of daily living. Currently, patients are out of bed within hours of surgery, engaging in activities that require a substantial range of motion in the treated knee. They are frequently discharged directly to home within 24 to 48 hours. We retrospectively reviewed two groups of patients undergoing primary total knee arthroplasty whose perioperative management differed only by surgical approach, namely, standard versus less invasive. Refined perioperative protocols in combination with a less invasive, mini-arthrotomy approach using special instrumentation resulted in earlier discharge to home, higher range of motion and improved clinical and pain scores.