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Institute of Advanced Orthopedics, MOSC Hospital and Medical College, Kolenchery, Ernakulam, Kerala


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This special approach for Knee joint surgery allows a faster return to activity, lesser pain and a smaller incision. This allows you to bend your knee faster and with lesser effort. Wound healing is faster and you return early to normal activities like walking and climbing stairs.

The traditional approach to knee replacement uses a long vertical incision in the center of the knee to view and access the joint. Minimally invasive total knee replacement is a variation of this approach. The surgeon uses a shorter incision and a different, less-invasive technique to expose the joint—with the goal of reducing postoperative pain and speeding recovery.

Our patients who undergo minimally invasive Total Knee Replacement surgery return to mild sporting activities like Cycling, Swimming or Golf in a very short time.





Who requires a Knee replacement surgery?  Know More>>

Surgical approach

In subvastus MITKR no cut is made on the underlying thigh muscle called the quadriceps. Instead the joint is approached below the muscle.

This has huge advantages such as not weakening the thigh muscles at all and this is the reason that the patients are able to walk even without holding on to any walking aids almost immediately after the operation. The traditional Medial parapatellar approach, which is still practised in many centres, involved cutting the quadriceps. If the quadriceps is cut, the patients typically need walking aids for 3 to 6 weeks to allow this cut to heal. Moreover, cutting the quadriceps causes more pain and delays the recovery from the operation.




Mini Incision

The instruments to implant the joint and the surgical techniques have been suitably modified so that the new knee joint can be implanted accurately through an incision less than 4 inches. This has advantages, as the lesser the cut on the skin, lesser is the pain and earlier the recovery.

Reduced pain during recovery

The mini TKR through the subvastus approach coupled with advanced postoperative analgesia reduces the pain associated with recovery after the operation. This allows the patients to bend the knee and walk freely very early in the post-operative period.

Full bending of the knee

The ability to achieve full bend of the knee requires the joint to be implanted perfectly.
Care is taken intra-operatively to ensure that the joint is bending fully on the operation table. This allows mobilization of the knee to begin immediately after the operation and to eventually achieve full flexion. The high flex and mobile joints that are available help in achieving this aim.

Squatting after Knee replacement

Full knee flexion after Knee replacement

Faster return to active life

Knee Replacement Surgery is getting more popular as it is very effective. However, some people are not yet considering it because of the length of its recovery and the belief that they would not be able to sit down, squat or kneel after the operation. This is even more relevant in Indian setting due to our cultural need for sitting on the floor for praying etc. Many people want to even squat and use Indian toilet after the operation. Recent technological breakthrough has allowed the recovery to be almost miraculous and function to be virtually normal, allowing the person with a replaced knee to squat and kneel

Atheletic competition for Joint Replacement Recipients

Atheletic competition for Joint Replacement recepients. The First prize winner had one Hip and both the Knees replaced by surgery.




During any knee replacement, the damaged cartilage and bone from the surface of the knee is removed, along with some soft tissues. The goal of knee replacement surgery is to provide the patient with a pain-free knee that allows for the return to daily activities and lasts for a long time.

Minimally invasive knee replacement differs from traditional knee replacement in that it uses an incision that is approximately half as long and fewer muscles are cut and detached.

Traditional Knee Replacement

To perform a traditional knee replacement, the surgeon makes an 8- to 10-inch vertical incision over the front of the knee to expose the joint. The surgeon will then:

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending on the case.
  • Insert a spacer. A plastic spacer is inserted between the metal components to create a smooth gliding surface.

Minimally Invasive Knee Replacement

In minimally invasive knee replacement, the surgical procedure is similar, but there is less cutting of the tissue surrounding the knee. The artificial implants used are the same as those used for traditional knee replacement. However, specially designed surgical instruments are used to prepare the femur and tibia and to place the implants properly.

Minimally invasive knee replacement is performed through a shorter incision—4 to 6 inches versus 8 to 10 inches for traditional knee replacement. A smaller incision allows for less tissue disturbance.

In addition to a shorter incision, the technique used to open the knee is less invasive. In general, techniques used in minimally invasive knee replacement are “quadriceps sparing,” meaning they avoid trauma to the quadriceps tendon and muscles in the front of the thigh. Other minimally invasive techniques called “midvastus” and “subvastus” make small incisions in the muscle but are also less invasive than traditional knee replacement. Because the techniques used to expose the joint involve less disruption to the muscle, it may lead to less postoperative pain and reduced recovery time.

The hospital stay after minimally invasive surgery is similar in length to the stay after traditional knee replacement surgery–ranging from 1 to 4 days. Physical rehabilitation is a critical component of recovery. Your surgeon or a physical therapist will provide you with specific exercises to help increase your range of motion and restore your strength.

Candidates for Minimally Invasive Total Knee Replacement

Minimally invasive total knee replacement is not suitable for all patients. You will be evaluated and several factors will be considered before determining if the procedure is an option for you.

In general, candidates for minimal incision procedures are thinner, younger, healthier and more motivated to participate in the rehabilitation process, compared with patients who undergo the traditional surgery.

Minimally invasive surgeries may be less suitable for patients who are overweight or who have already undergone other knee surgeries.

In addition, patients who have a significant deformity of the knee, those who are very muscular, and those with health problems that may slow wound healing may be at a higher risk for problems from minimally invasive total knee replacement.



Surgical Pictures


Smaller incision


Lesser tissue damage

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