N°276 - August/September 2018
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SURGICAL APPROACH FOR TKP REVISIONS - Exposure of the knee and management of the extensor mechanism
By A. Pinaroli, L. Buisson, G. Estour in category TECHNIQUE
Medipôle de Savoie Avenue des Massettes, 73190 Challes-Les-Eaux / www.orthopedie-savoie.fr
Revision and replacement surgery for total knee prostheses is difficult (7). The surgical approach and the exposure of the knee – and, in particular, management of the extensor mechanism - are probably the most significant technical elements of the intervention. This stage of surgery is most often dictated by the pre-existing conditions of the failing knee replacement (e.g. cutaneous scarring, previous arthrotomy, extensor mechanism function and stiffness). The approach to and exposure of the femur may also be adapted in accordance with the choice of constraint for the revision prosthesis. Finally, the choices made as to the approach will sometimes dictate postoperative sequelae in terms of knee mobility and postoperative immobilisation in particular.
Overall, the choice of incision, the surgical approach and the technical ploys that may be needed in order to expose the extensor mechanism must, without fail, be decided preoperatively (2), according to surgical indication (e.g. laxity, stiffness in flexion, stiffness in extension, patella baja and so on). The exposure of the knee is adaptable based on the choice of prosthetic constraint (the collateral ligaments may be sacrificed if a hinged prosthesis is indicated).
These choices must be anticipated in advance of the...
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