Muscle-Sparing Total Knee Replacement

This innovative technique combines the latest minimally invasive methods with a surgical approach that leaves key muscles and tendons intact. Instead of cutting the quadriceps tendon, surgeons make a 3-5 inch incision on the knee and split or dissect under a single quadriceps muscle. Because the incision is very small and no major tendons or muscles are cut, recovery is faster and less painful.

Watch this video to learn more about muscle-sparing total knee replacement

Get Up & Go!

Advanced Joint Replacement Techniques, Multimodal Pain Management Quickly Restore Function, Lifestyle

Muscle-Sparing Total Knee Replacement

For more than five years, Jerri ignored the increasing pain in her left knee. The 64-year-old Alexandria psychotherapist knew she’d ultimately need a knee replacement, but she wasn’t ready to give up her active, athletic lifestyle. She spent busy days seeing patients, performing community work with the homeless, and keeping up with her six grandchildren. Running, swimming, biking, and boating were often on her schedule.

But when the pain finally forced her to limit her activities, she knew she had to take the plunge. “The most important thing for me was finding a physician and a team that were eager to partner with the patient and focus on early mobilization to ensure the best possible outcome,” she says.

A three-month search led her to Commonwealth Orthopaedics and surgeon Mark Hartley, MD, who performed a state-of-the-art, minimally invasive muscle-sparing total knee replacement in December 2008.

This innovative technique (also called quad-sparing knee replacement) combines the latest minimally invasive methods with a surgical approach that leaves key muscles and tendons intact. Instead of cutting the quadriceps tendon, surgeons make a 3-5 inch incision on the knee and split or dissect under a single quadriceps muscle. Because the incision is very small and no major tendons or muscles are cut, recovery is faster and less painful.

“Muscle-sparing knee replacement offers patients numerous advantages over traditional knee replacement,” says Dr. Hartley. “Patients have more rapid return of knee function and regain muscle strength and control more quickly. The technique leaves the quad extensor mechanism intact, so patients are able to lift and bend their leg within the first hours after surgery. Later, when we take them to their hospital room on a stretcher, they walk from the door to their bed, which is quite remarkable.”

Jerri opened her eyes after surgery to see a list of musclestrengthening exercises on the ceiling and began lifting and flexing her leg right away. A few hours later, she walked from her hospital room out into the hallway and back to her bed. “My goal was to become very active, very quickly and Dr. Hartley and his team gave me plenty of opportunities to realize my capacity and achieve my objectives. They told me there was no reason I couldn’t walk right away and I did,” she says.

Her pain was short-lived and very manageable, like “dental surgery.” And her recovery was equally successful. After two nights in the hospital, she returned home and began physical therapy. Within three weeks, she was back at work part-time and climbing the stairs to her office. Soon, she was walking two miles a day. A month later, she helped her husband set up hypothermia shelters for the homeless, a task that involved much physical labor. “There were absolutely no limitations,” she recalls.

With the advent of smaller instruments, computer-assisted navigation, improved retractors and implants, and better pain protocols, muscle-sparing knee replacement has taken off in recent years, and Commonwealth is on the cutting-edge of performing this technique. “It’s revolutionized early ambulation and function and minimized pain. When you combine it with a small incision and multimodal medication approach, patients such as Jerri really get up and go very quickly,” Dr. Hartley says.

Knee problems are the most common reason patients visit orthopaedic surgeons and osteoarthritis, fractures, and wear and tear injuries are among the most common reasons for knee replacement. “Most everyone is a candidate for this procedure unless they have a lot of scar tissue from previous surgeries or are severely overweight. But for 85-90% of patients, this is the knee replacement approach of choice,” says David Romness, MD, who performs muscle-sparing knee and other total joint replacements at Commonwealth.

More than a year out from surgery, Jerri continues to excel. She calls her Commonwealth experience “quite amazing” and credits superior patient education from a caring and attentive team as key in helping her reach her goals. “From the beginning, their focus is on wellness and restoring a high level of function,” she says. “They don’t set any barriers or say you can’t do things well afterwards. They ask you what you want to do and work with you to make a plan to get it done. It’s a true partnership.”

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