Prof. P Aglietti Director of the First Orthopedic Clinic University of Florence, Italy

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Guarantees, guarantees

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MIS TKA today Prof. P Aglietti Director of the First Orthopedic Clinic University of Florence, Italy

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Promises, guarantees … Less injury Less torment Less blood misfortune Faster restoration Better cosmesis

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Mini-Subvastus versus Traditional Medial ParaPatellar Prospective, coordinated case-control consider Implants: LPS (stemmed tibial segment) Analgesia: femoral nerve piece + PCEA Mini-Subvastus – 60 TKA Traditional Medial ParaPatellar – 60 TKA Boerger-Aglietti, CORR 2005

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Mini-Subvastus L-molded capsular cut

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Limited limit analyzation over the septum

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Tibia first (in situ) Patella not everted

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Distal cut from average

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Exposure of both condyles

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Complete conservation of VMO inclusion

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Results: for Mini-SV Less blood misfortune Less agony day 1 Earlier SLR 90° achieved sooner (factually critical)

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Disadvantages of Mini-SV More tourniquet time More intricacies (one every): PT burst Lateral condyle crack Varus tibial segment Initial understanding

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Limitations of MIS Inflammatory joint pain Restricted flexion (under 80°) Patella infera (IS-R < 0.6) Morbid corpulence (BMI > 35.0) Risk of ischemic skin complexities Very serious disfigurements (more than 20°) Large strong guys

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Hypothesis Could we get similar MIS focal points with a shorter however more routine approach, with not so much confusions but rather more accuracy ?

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Limited ParaPatellar Quad entry point 5 cm above patella No patellar eversion

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Femur first: distal cut from foremost (with scaled down instrument)

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Femoral segment measuring/pivot

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Femoral a/p cuts (cut back cutting piece)

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Tibial cut with tibia subluxed forward (EM cutting dance)

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Complete tibial presentation for an assortment of tibial inserts

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Fluted High flex portable RP Mini-bottom TM

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Limited ParaPatellar versus Mini-Subvastus approach Prospective coordinated case-control concentrate Same embed (LPS) and multimodal torment administration Limited ParaPatellar – 30 TKA Mini-subvastus – 30 TKA Sensi-Aglietti, submitted to KSSTA 2007

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Clinical outcomes Subjective

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Clinical outcomes Objective

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Radiographic outcomes

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Mini-SV radiographic "blemishes" Tibial medialization Retained concrete

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1. Conclusion The Mini-Subvastus had simpler recuperation however a greater number of inconveniences and more tourniquet time than the Traditional Parapatellar approach.

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2. Conclusion Less obtrusive TKA is not for everyone: it has numerous impediments or contraindications.

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3. Conclusion The Limited ParaPatellar was just somewhat substandard compared to the Mini-Subvastus in the main weeks after surgery, yet with less tourniquet time and enhanced radiographic outcomes.

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4. Conclusion Outcome of TKA is multifactorial: "Less obtrusive" surgical system Preop understanding training with clear desires Postoperative torment control Rehabilitation

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5. Conclusion "Less intrusive" system: Reduced QT cut No patella eversion No tibial subluxation ?

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6. Conclusion The "less obtrusive idea" is setting down deep roots. It has invigorated new specialized arrangements, with little savvy instruments and new surgical abilities.

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Risks and advantages Comfort zone for the specialist

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The significance of being MIS M inimally IS M edium IS M aximally IS