5 Key Steps for Achieving a Successful Revision TKA
At ICJR’s 7th Annual Revision Hip & Knee Course, R. Michael Meneghini, MD, from Indiana University School of Medicine in Indianapolis, shared the tips, tricks, and techniques he relies on for a successful revision knee arthroplasty (TKA):
Optimal surgical exposure. The most important part of any knee revision is the exposure. The goal is to ensure that all structures can be seen and that damage to the extensor mechanism is avoided. The video Dr. Meneghini showed included tips on the initial exposure of the knee and extensile exposure when needed.
Tibial platform. To create a perpendicular tibial platform, Dr. Meneghini establishes the neutral mechanical axis on the tibia and makes his cut. This is the essential first step in building a good platform for the revision knee construct, he said. Because he uses short stems, he does not ream the canals; he wants to maintain the cancellous bone.
Bone defect reconstruction. Along with neutral mechanical alignment of the tibia, a successful revision TKA requires good structural support of any bone defects. This support can be created through the use of metaphyseal cones, Dr. Meneghini said, and using a surgical video, he demonstrated an efficient technique for reaming for the cones.
Femoral component positioning. Positioning the femoral implant in 3-dimensional space is critical to the stability of the construct, Dr. Meneghini said. This allows for balancing of the flexion and extension gaps and maintenance of the joint line.
Cemented short stem. Dr. Meneghini typically cements both components at the same time, although he will cement the tibia first and then build off it when the patient has a tenuous tibia. He also noted that there is no way to truly pressurize the cement in a knee replacement, unlike in a hip replacement, but the surgeon should make every effort to pack the cement as much as possible when using a short stem.
Click the image above to watch Dr. Meneghi’s presentation and learn more about the essential surgical steps for a successful revision TKA.
Disclosures: Dr. Meneghini has disclosed that he receives royalties from and is a paid consultant for DJO Global.