ICJR REWIND: Optimizing Exposure and Component Removal in Revision TKA
In a presentation from ICJR’s 7th Annual Revision Hip & Knee Course, Peter K. Sculco, MD, reviewed:
- Basic and advanced techniques for exposure in revision total knee arthroplasty (TKA)
- Techniques for TKA component removal, as well as the tools surgeons may need for successful component extraction
Revision TKA, of course, is a maximally invasive procedure, requiring the surgeon to extend the incision proximally and distally to visualize not only the components, but also the normal anatomy and tissue planes to help with the procedure, Dr. Sculco said. He also noted that the longer incision will reduce the stress on the skin, avoiding skin tears.
Both exposure and component removal can be done in a stepwise fashion:
Using a medial parapatellar approach, the surgeon should follow this sequence to optimize exposure:
- Release under the patella
- Posteromedial corner release
- Lateral release (if needed)
In some cases, additional techniques are needed for exposure, including quad snip, medial femoral peel, tibial tubercule osteotomy, and V-Y turndown (very rare). Dr. Sculco reviews these in his presentation as well.
Surgeons should aim for a safe, expedient component removal that preserves bone and protects the extensor mechanism. Poor implant removal technique can jeopardize the joint reconstruction. Dr. Sculco recommends this order of component removal:
- Polyethylene tray
- Femoral component
- Tibial component
- Patella component
Click the image above to hear more from Dr. Sculco on exposure and component removal in revision TKA.
Disclosures: Dr. Sculco has no disclosures relevant to this presentation.
This presentation was originally posted on ICJR.net on May 15, 2019.