Abstract
After over 4 decades of experience with total knee arthroplasty, many lessons have been learned regarding surgical technique.
These include exposure issues, alignment methods, bone preparation, correction of deformity, implantation techniques and wound closure.
Where is the proper placement of the skin incision relative to the tibial tubercle? How does one safely evert the patella in the obese or ankylosed knee? Can a tibial tubercle osteotomy be avoided in the ankylosed knee? How does one protect the patellar tendon insertion from avulsing? How do you protect the soft tissues from debris and contamination and minimise the potential for infection? Can exposure be maintained if there are few surgical assistants? How do you find the lateral inferior genicular vessels and minimise postoperative bleeding? How do you know where to enter the intramedullary femoral canal for placement of the distal femoral alignment device? How can you avoid notching the anterior femoral cortex when in-between sizes or there is a pre-existing dysplastic trochlea? How can you correct a varus deformity without performing a formal MCL release? An inverted cruciform lateral retinacular release effectively corrects a severe valgus deformity and avoids the need for an LCL release. Trimming the posterior femoral condyles and removing posterior osteophytes is best accomplished using a trial femoral component as a template. Zone 4 femoral bone-cement radiolucencies can be minimised using the “smear” technique. The best indicator of potential postoperative flexion is not preoperative flexion but is intraoperative flexion against gravity measured after capsular closure.
