SURGICAL PEARLS: Performing an Efficient Revision TKA
R. Michael Meneghini, MD, from Indiana University School of Medicine in Indianapolis, has a busy primary and revision total joint arthroplasty practice – which has given him ample opportunity over the years to fine-tune his techniques.
At ICJR’s Pan Pacific Orthopaedic Congress, Dr. Meneghini shared his top tips, tricks, and surgical pearls for revision total knee arthroplasty.
Tip 1: Use an efficient, simplified system.
This is advice echoed by other faculty at the Pan Pacific meeting. A streamlined process with minimal trays is easier on the staff and helps to make the entire procedure more efficient.
Tip 2: Establish the tibial platform
Dr. Meneghini demonstrated his procedure for tibial preparation – including reaming, cutting the tibia, using the sizing guide, broaching, and inserting the trial implant – to ensure correct implant sizing and alignment in proper rotation with no medial overhang.
Tip 3: Ensure efficient bone defect reconstruction
Dr. Meneghini uses metaphyseal cones to fill defects in the tibia. He had previously used trabecular metal cones, which he said worked well but took time to position.
The system he now utilizes, which he helped to develop, has 1 conical reamer that creates a secure fit for the cones, providing good opposition of the bone to the highly porous metal.
Tip 4: Position the femoral implant in 3-dimensional space to balance the flexion and extension gaps and maintain the joint line
With the tibial platform established, Dr. Meneghini turns to the femoral side of the revision. He prefers to balance the flexion and extension gaps before making any freshening cuts in the femur so that he knows if he will need to add augments or remove additional bone.
Tip 5: Cement in short stems
Dr. Meneghini prefers short stems to long stems: If a re-revision is needed, it will be easier for him to remove the short stem. In the case of bone loss, he will augment the bone with metaphyseal filling devices rather than use a long, cemented stem in the femoral canal.
In addition, he compresses the cement in the femoral canal to ensure good fixation of the short stem.
Click the image above to watch Dr. Meneghini’s presentation.