Surgical Exposures in Revision Total Knee Arthroplasty

Abstract

Revision total knee arthroplasty is a demanding procedure that requires attainment of adequate surgical exposure to achieve a successful outcome. In the revision setting, the anatomy of the soft-tissue envelope has been disrupted by prior surgery and subsequent formation of scar tissue. Sufficient exposure must be achieved to enable implant removal, restoration of the joint line, balancing of the soft-tissue structures that confer stability to the joint, and proper alignment of revision implant components. Potential complications attributable to lack of adequate surgical exposure include iatrogenic disruption of the infrapatellar ligament, injury to the collateral ligaments, wound necrosis, neurovascular injury, and implant malalignment. Preoperative assessment should include a thorough history; physical examination; documentation of range of motion, stability, and prior scars; radiographic analysis; and evaluation for infection. This article will address strategies for extensile surgical exposure in revision total knee arthroplasty, including extracapsular and intracapsular approaches, excision of scar tissue, patellar turndown, rectus snip, epicondylar osteotomy, circumferential femoral exposure, and tibial tubercle osteotomy.

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