I was out hiking with an Audubon group and happened to compare my knee replacement surgery with another guy’s. He had the standard full-length incision three months ago and looks great. His incision is healed beautifully and he has enough motion to kneel and get up and down from a log on the trail. I had the minimally invasive approach six months ago. My scar looks just as long as his and I still only have 90 degrees of knee flexion. I thought the minimally invasive approach was supposed to be better.

There is still quite a bit of controversy and debate over the way to do total knee replacements. Does a smaller incision and less invasive approach really make a positive difference? There are studies reporting benefits of minimally invasive over traditional and others showing no differences between the two.

Some studies have shown that the benefit with minimally invasive total knee replacement is early on in the post-op period. Patients report less pain, faster recovery of knee motion, and shorter stay in the hospital. But there are other studies that fail to show any benefit (early or late) of the minimally invasive technique compared to the conventional (full incision) approach.

Scars range in length for the minimally invasive approach from about four and a half inches up to five and a half inches. The scar used with a traditional open approach is more like seven to eight inches.

Sometimes a minimally invasive approach ends up being a conventional approach. This can happen when the surgeon sees it is necessary to make a longer incision to get to the knee joint. It may be that getting the implant situated in the joint with perfect alignment requires a larger incision. In some cases, there is so much soft tissue around the knee that a minimally invasive incision just won’t be enough to get to the joint.