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When looking at a knee like this, ¿what is the best incision that you should use? ¿What type of quadriceps exposure is necessary
depending upon the range of motion, plus or minus a synovectomy?
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In preoperative planning, the history, old notes, and physical
exam are self-explanatory
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Early flapping is better than late flapping. When we have a patient
who we think has compromised soft tissue, we will have a plastic surgeon
on hand to do a reconstructive procedure at the time of the
reimplantation or the revision
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Multiple incisions: We are aware of using the most lateral-based incision, because of the blood supply comes from the medial
side.
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If the incision is well-healed, it is 20 years old, it is mobile, it is not that deep invagination,
sometimes we will choose the more medial incision, because we can do more dissection.
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Consulting the infectious disease doctor is paramount if we think an infection is
present
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If flexion > 100 degrees and the revision is not extensive, we can try to do a midvastus
or subvastus approach.
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The median parapatellar is probably the most commonly used
approach on both primary and revision knee arthroplasty.
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A synovectomy aids in exposure. Possibly is underutilized. Getting all of the synovium out of the gutters
will help lateralization of the patella and, more importantly, avoid the
need for a lateral release
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Slide the patellae laterally. That reduces the stresses across the
patellar tendon
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The purpose of these enhanced exposures is to avoid extensor
mechanism disruption
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You can do a beautiful knee reconstruction and if the extensor mechanism fails, then you have
quite a problem.
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cut it at about a 45-degree angle into the muscular-tendinous junction
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Reasonable follow-up in terms of function, pain,
and stiffness
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offers great femoral exposure
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•Effective in the patient who has a very stiff knee. •Prior scarring of the quadriceps mechanism.
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Long tibial osteotomy, 8
to 10 cm, as thick as possible
Repair tibial tubercle
osteotomies with cerclage
wires
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Arthrofibrotic kneeCollateral ligaments encased in scar
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