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“WANDERING RESIDENT” CAPSULAR INCISION FOR ONE OR TWO STAGE REVISION REPLACEMENT IN STIFF ASEPTIC AND SEPTIC KNEE ARTHROPLASTY



Abstract

Forty-two revision knee replacements were performed in our department between 1992–2000. We report our experience in 18 cases of stiff knees with a range of motion from −5° – 75° (average 50°) where an oblique incision through the quadriceps tendon combined with medial capsular incision (the “wandering resident” incision) was used for exposure. This exposure allowed us to expose the stiff knee with no hazard of avulsion of the patellar tendon and with easy removal of the old prosthesis and implantation of the new one. In 5 of these cases, this exposure was used twice in two stage revisions of a septic prosthesis.

Post-operative rehabilitation was slower, a knee brace was used in extension for 6 weeks and daily physiotherapy and CPM from 0°–70° only. Full range of motion was started after 6 weeks. Follow-up in 1–8 years (average 3.5 years).

All patients had good clinical results with range of motion from 0°–110° (average 86°). One patient had a lag of 10° in active extension. The knee score of the American Knee Society ranged from 35–52 (average 40) and improved to 72–89 (average 84).

In 3 cases, we used a non-constrained prosthesis (PCL) sacrificing condylar prosthesis), in 11 cases a constrained prosthesis (CCK type) and in 4 cases a rotating hinge prosthesis.

The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.