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Surgical exposures in revision total knee arthroplasty

Department of Orthopaedics, University of British Columbia, Vancouver, Canada.

A well-planned operative approach to revision total knee arthroplasty is crucial to a successful outcome. Wide exposure must be achieved to allow component removal, soft-tissue balancing, management of bone loss, and reimplantation without damaging important structures. These structures include skin, the extensor mechanism, the collateral ligaments, the remaining bone stock, and neurovascular structures. Skin necrosis can be avoided by selecting the appropriate incision and dissecting deep to the fascia. Extensile exposure by dissection of scar, quadriceps snip or turndown, tibial tubercle osteotomy, or medial epicondylar osteotomy should be performed early to prevent patellar tendon disruption. In certain cases, the distal femur can be exposed circumferentially by using a quadriceps myocutaneous flap or femoral peel. Special care should be taken with the infected or ankylosed knee.