Abstract
Exposure for revision knee requires using the previous incision, employing the “quad snip”, the “Banana Peel”, or the tubercle osteotomy.
The “quad snip” is a 45-degree incision of the proximal extensor mechanism that helps protect the distal insertion on the tubercle.
The “banana peel,” is my exposure of choice and has been used extensively for revision total knee arthroplasty (TKA) for more than 20 years in my community. We retrospectively reviewed use of this technique in a cohort of 100 consecutive patients who underwent tibial-femoral stemmed revision TKA. The technique involves peeling the patella tendon as a sleeve off the tibia, leaving the extensor mechanism intact with a lateral hinge of soft tissue. A quadriceps “snip” must be done proximally to avoid excessive tension. No patient has ever reported disruption of the extensor mechanism or decreased ability to extend the operative knee. With a mean Knee Society score of 176 (range, 95–200). Post-operative motion was 106 degrees. No patient reported pain over the tibial tubercle. The “banana peel” technique for exposing the knee during the revision TKA is a safe method that can be used along with a proximal quadriceps snip and does not violate the extensor mechanism, maintaining continuity of the knee extensors.
As a last resort, tibial tubercle osteotomy as described by Whiteside, is preferred for revising porous coated stemmed tibial components and is repaired with cerclage wire or cables. Keep the osteotomy fragment at least 8–10cm long leaving a lateral soft tissue attachment.
