Abstract
Systematic surgical exposure during revision total knee arthroplasty is essential for revision surgery. Surgical exposure protects the extensor mechanism, facilitates safe implant removal and allows for accurate reimplantation of components. The pre-operative plan is critical to achieving appropriate exposure in the revision setting. Evaluating the skin and previous incisions will aid in the exposure technique selected.
The key to revision total knee arthroplasty is systematic releases. Revision total knees can be exposed with a standard medial parapatellar arthrotomy, a proximal medial tibial peel, and a quad snip. This takes tension off the stiff knee, is easy to repair, and does not require limitation of rehabilitation protocols. The patella need not be everted in the revision surgery. The Banana Peel technique is very helpful for the stiff knee. The tibial tubercle osteotomy can also be utilised in patients with extreme stiffness and can aid in removal of well-fixed tibial stems. Keep the osteotomy long (8–10 cm) and leave a lateral soft tissue bridge. Other techniques such as the quadricepsplasty or V-Y turndown are rarely needed.
