Minimally Invasive Surgery
Minimally invasive surgery for orthopaedic conditions allow a more rapid return to normal function, and reduces the load on the body after surgery. In general, minimally invasive surgery is more technically demanding, but can result in a more rapid rehabilitation. The concept of minimally invasive techniques for shoulder, hip and knee surgery is not new. For decades, orthopaedic surgeons have been looking for ways to improve the outcomes of patients by reducing the areas that need to heal after surgery.
For arthritis, total hip replacements, total knee replacements and total shoulder replacements can be performed via minimally invasive approaches. These are not commonly used often as they can be more difficult to perform, and have a learning curve that is longer than other methods. Some studies show benefits whilst others do not. Once trained and competent, these techniques can yield benefits above and beyond what other methods can.
Dr Chien-Wen Liew is a true believer of minimally invasive surgery, and has trained in techniques on hip, knee and shoulder arthritis and sports injury, as well as in trauma surgery.
For surgery to be minimally invasive, it is what occurs under the skin that is more important than the size of the skin incision. In most cases, muscles and nerves should be respected (i.e. using tissue planes that go between areas supplied by different nerves), and bleeding should be reduced. A decrease in blood loss may also reduce infection risk as there is less haematoma under the skin to act as a nidus for infection. Orthopaedic surgeons can utilise a multitude of approaches to the hip, knee and shoulder, and often it is the one that they perform most frequently that has the best outcomes in their hands.
In total hip replacements, the Direct Anterior Approach uses a muscle plane that goes between muscles of the hip, avoiding cutting them from bone. The recovery and rehabilitation after a total hip replacement performed via a Direct Anterior Approach is in general, fast.
For total knee replacements, Dr Liew performs either a medial parapatellar or subvastus approach for appropriate patients. The VMO (Vastus Medialis) remains attached to the quadriceps mechanism.
Dr Chien-Wen Liew gives regular patient and doctor talks on performing the Direct Anterior Approach for total hip replacements and the Subvastus Approach for Total Knee Replacements. To remain up to date on events, please return to this site, or visit the practice webpage at www.aots.net.au
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