Video Gallery

Video Gallery

To View the Video

Three-step Technique For Revision Total Knee Arthroplasty (TKA): Tips and Tricks

February 19, 2016

Contributors: Davide E Bonasia, MD; Umberto Cottino; Federico Dettoni, MD; Matteo Bruzzone, MD; Roberto Rossi, MD; Federica Rosso, MD; Federica Rosso, MD

2016 AWARD WINNER This video shows the three-step technique for revision total knee arthroplasty, describing the various steps and focusing on crucial aspects of the procedure. The first step involves the tibial platform. The tibial surface is fundamental with regard to restoring flexion and extension gaps. Intramedullary fixation often is required. Crucial aspects of the first step include locating the diaphyseal canal, which may not correspond to the center. Surgeons must determine if offset stems are necessary. Offset stems are recommended in patients with a tibial diaphysis deformity. Surgeons also must determine how to manage bone loss. Metal augments are necessary if a bone defect is larger than 10 mm. The second step involves stabilization of the knee in flexion. Surgeons must select the size of the femoral component. A common mistake involves measuring existing bone and fitting the corresponding femoral component to match existing bone. The bone defect on the posterior femoral condyle often is a problem during revision surgery, and a metal augment helps avoid the placement of a component that is too small. Longer stems are recommended in patients with bone loss. In patients with diaphyseal alteration and patients in whom translation of the component is necessary, an offset stem may be useful. The femoral component should be seated in external rotation. Use of the epicondylar axis as an anatomic landmark may not be possible because of bone loss. The presence of a larger amount of posterior femoral condyle medially rather than laterally is a sign of internal femoral rotation. A lateral posterior metal augment can be used to restore external rotation. The joint line must be reestablished. In patients in whom the epicondyles cannot be used as a landmark, the lower pole of the patella with the knee flexed 90° or the meniscal scar may be good landmarks. In patients in whom the joint line has to be raised, a tibial wedge is preferred over a ticker polyethylene insert. The third step involves stabilization of the knee in extension. If the extension gap is larger than the flexion gap, then the femur should be distalized and the thickness of the polyethylene insert should be increased. If the extension gap is too tight, then a femoral re-cut can be performed. Careful evaluation of patellar height and the collateral ligament attachments is necessary.

Results for "Revision Knee Arthroplasty"

1 of 2
1 of 2

X