Surgical Exposures in Revision Total Knee Arthroplasty

UNLABELLED: Safely obtaining adequate exposure at the time of revision total knee arthroplasty is an integral step in successfully performing the procedure. A medial capsular approach combined with an extensive intraarticular synovectomy provides adequate exposure for most patients. If further exposure is required, a quadriceps snip can be used to free the proximal extensor mechanism. The benefits of this approach include its technically simple nature and an unaltered postoperative rehabilitation regimen. We report a series of 126 consecutive revision knee procedures in which a medial capsular approach was adequate in 111 cases, representing 92% of the patients with an intact extensor mechanism. A quadriceps snip was required in nine cases. If more extensive exposure is required for an excessively stiff or difficult to expose knee, a tibial tubercle osteotomy or V-Y quadricepsplasty provides wider exposure. LEVEL OF EVIDENCE: Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.