Dr. Matthew Abdel’s Tips and Techniques for Revision TKA

    At ICJR’s Winter Hip & Knee Course, Matthew P. Abdel, MD, from Mayo Clinic in Rochester, Minnesota, shared the tried-and-true techniques he relies on for surgical management of revision total knee arthroplasty (TKA) patients.

    Wide exposure is needed, including well-developed gutters.

    Dr. Abdel is fairly aggressive with removing tissue, mobilizing the retinaculum tissue down to the quadriceps and patellar tendons. He also does a substantial medial release that provides the wide exposure he needs in 95% of cases, accomplishing this by flexing and externally rotating the knee after the medial release and delivering the anteromedial and posteromedial aspects of the tibia out of the wound.

    He’ll do a quadriceps snip if needed for better exposure, which he explains in detail in his presentation.

    Use a combination of a thin saw blade and flexible osteotome to remove the tibial and femoral components of the implant.

    Dr. Abdel first passes a thin saw blade from the posteromedial to the posterolateral sides of the tibial component, which he says is the safest way to avoid fracturing the lateral tibial plateau and is easier than going around the keel and extensor mechanism to loosen the tibial tray.

    After using the saw blade, he switches to a flexible osteotome and repeats the process. Then he goes back and uses the saw blade and the flexible osteotome a second time. Only then will he disimpact the tibial component.

    For removal of the femoral component, Dr. Abdel recommends that surgeons reverse-engineer implantation of the component by passing the saw blade through the original cuts: anterior flange, anterior chamfer, distal, posterior, and posterior chamfer. Again, he uses the combination of a saw blade and flexible osteotome, repeating the process as with the tibial component before disimpacting the femoral component.

    Utilize an intramedullary drilling device when placing a cone.

    Cones allow for metaphyseal fixation in patients who have significant bone loss in the tibia. An intramedullary drilling device makes placement of the cone easier in a difficult reconstruction, Dr. Abdel says.

    A synthetic mesh graft is an alternative for repairing the extensor mechanism.

    The use of a synthetic mesh graft has become the preferred treatment option for extensor mechanism disruption at Mayo Clinic. In a patient with this dramatic complication of TKA, Dr. Abdel will repair the extensor mechanism at the time of the revision to avoid creating a tibial trough.

    He describes his technique in the presentation and goes into more detail in a presentation from ICJR’s Revision Hip & Knee Course, available here.

    Use patellar bone grafting when the patient has a deficient patella.

    In a patient with a patella that’s 10 mm or less and has viable bleeding tissue, Dr. Abdel uses scar tissue from the quadriceps and patella tendons to form a “pouch” that will hold the bone graft. He describes and demonstrates his technique in the presentation.

    Click the image above to watch Dr. Abdel’s presentation and learn more about this tips, tricks, and techniques for revision TKA.

    Disclosures: Dr. Abdel has disclosed that he is a paid consultant for Stryker.