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Orthopedic MIS Comes of Age

Minimally invasive surgeries, once predicted to replace open surgeries across the board, have never taken off to a great degree, because MIS required more intricate and demanding manipulations that were uncomfortable, if not outright impossible for surgeons. It is against this background of MIS's stalled success that the adoption of minimally invasive techniques in that most unlikely of surgical specialties, orthopedics, and in particular, hip and knee joint replacements, is most amazing. A half decade after the introduction of the first true MIS procedures in total hip replacement, orthopedic surgeons have continued to push penetration rates of MIS well beyond what anyone might have expected.

More than two decades ago, the advent of minimally invasive surgical (MIS) approaches promised to revolutionize the practice of surgery. Beginning in general surgery, and in particular gallbladder surgery (laparoscopic cholecystectomy), less-invasive and laparoscopic techniques offered an array of benefits, including significantly reduced pain and trauma, shorter lengths of stay in the hospital, and much faster recovery times, including a quicker return to work. Surgeons were quick to learn the new procedures as patients drove demand (MIS soon became one of the few phenomena in medicine driven as much by consumer demand as physician supply) and hospitals, payers, and employers applauded.

Through the 1980s and 1990s, however, that much-vaunted MIS revolution stalled. Beyond lap cholys, MIS penetration in a wide range of other surgeries—from other GI procedures such as Nissen fundoplications...

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