JIFFY KNEE REPLACEMENT
“There is nothing “minimally invasive” about knee replacement surgery. But we can certainly do it with less trauma and damage to the tissues around the knee than what has traditionally been done.”
Traditional Approach to the Knee
For decades now, the “standard” approach, or incision and entry into the knee, has been what is termed the ‘medial parapatellar approach.’ This allows the surgeon to be able to move the patella (knee cap) over to the side and access the inside of the knee and perform the surgery. This approach involves the surgeon typically making the skin incision along the front part of the knee, sometimes directly over the front of the knee cap (where the skin is on the most tension) and then continuing down to what is called the knee capsule. The capsule is then cut along the medial border of the tendon and knee cap. However, at the top part of the knee cap, a muscle called the vastus medialus obliqus (or VMO) comes and attaches to the knee cap bone. This typical approach teaches that in order to move that knee cap to the side, we have to cut through that muscle attachment and into the tendon next to it, the Quadriceps tendon. From there the knee cap can then be pushed to the side of the knee, the surgery is performed, and then the cut muscle and tendon are sutured back together at the end of the surgery.
The issue with this approach to get into the knee is that the muscle and tendon that are cut are vital to the straightening of the knee. They are sewn back together at the end of the surgery, and they still function, but because they have been cut the patient feels pain each and every time that muscle contracts, like when they walk. This makes the early recovery after knee replacement painful. The tendon and muscle can take around 6 weeks to heal.
Jiffy Knee - A medial oblique subvastus approach
The subvastus approach to the knee was described long ago. However, many surgeons do not use or teach it because the traditional teaching was that access and visualization of the knee was too limited through this approach. Trying to do a knee replacement without enough access to different parts of the knee can result in the knee replacement being put in poorly, and therefore the result being less than ideal.
However, the subvastus approach has been revisited in recent years, and through a series of simple fascial releases, more-than-adequate visualization of the knee has been achieved on a consistent and reproducible basis. In fact, the visualization is actually improved when compared to the traditional medial parapatellar approach in almost all cases. The increased visualization and the lack of damage or cutting to the VMO and quadriceps tendon has made a drastic difference in the amount of pain patients experience after surgery, and thereby has sped their recovery. It has been so significant that the surgeon that pioneered this revisiting of the approach has coined the term JiffyKnee to describe it.
We've seen this before...
Hip surgeons know the history of approaches to the hip replacement. It is interesting that the hip went through a similar evolution as what we are now seeing with the JiffyKnee. Decades ago, an ‘anterior based’ approach to enter into the hip joint was described. However, as surgeons started doing more hip replacements, the anterior approach was deemed to not be suitable as it did not allow appropriate access and visualization (sound familiar?). So the most utilized approaches were the lateral and posterior approaches, which both involved cutting through muscle and tendons and resulted in pain, limp, and even dislocations of the hip replacements.
Over time, surgeons revisited the described anterior approach. They began to find releases that would allow for better access to the parts of the hip that are replaced, and developed retractors and other tools to facilitate hip replacements from the anterior approach. Soon, hip replacements were done successfully and with minimal complications, and surgeons and patients were noticing that the recovery was faster, easier, and less painful.
The Naysayers
When the anterior hip replacement started to be talked about, there were many surgeons that argued that it was all just ‘a marketing scheme’ or that ‘eventually the complications will come to light.’ However, as results continued to improve, complications were kept to low levels, and patients continued to ask for the approach for the potential benefit of an easier recovery, more and more surgeons eventually adopted the technique. Now, the anterior approach is widely taught and used throughout the country and world, and is the preferred technique by the majority of hip surgeons in the U.S.
At the Forefront of Knee Surgery
I share the opinion of those that have tried the Jiffy Knee approach that this is the knee’s “Anterior Approach” moment. As someone that has performed many knee replacements through the standard approach, the results of the JiffyKnee have been almost shocking to me. The best part of it for me is hearing the patients say how pleasantly surprised they have been with their recovery and how quickly they feel better.
Disclaimer
As I routinely discuss with my patients, not every patient has the same outcome from a surgery, even if the surgery is done exactly right and the same way from patient to patient. It is just a factor of each individual being different and having different genetic predispositions for different outcomes. There are never any guarantees in surgery or outcomes, and this is no different. While I have seen an exciting difference in the majority of patients who have the JiffyKnee compared to the traditional approach, it in no way guarantees or implies that every patient will have a similar outcome.
