Minimally invasive total knee arthroplasty: is it for everybody?

The development of new instrumentation and techniques has led to the rapid advancement of less invasive surgical approaches in total knee arthroplasty (TKA). Compared to the standard approach, minimally invasive surgery (MIS) in TKA was shown to reduce postoperative pain, blood loss, and hospitalization time, and to improve functional recovery. Growing experience with MIS-TKA has defined the proper indications for this technique. With a limited exposure, the skin, capsular tissues, and bone surfaces receive higher stresses because of the retraction required. Several complications relating to the MIS learning curve are now being reported. The reliability of a TKA procedure performed through a mini-incision, and its success, seems to depend on patient selection, surgeon experience, and surgical environment.