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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

In this video we briefly show the three-steps technique to perform a total knee arthroplasty (TKA) revision, describing the different steps and focusing on some crucial points.

First step: tibial platform. Tibial surface is fundamental in restoring flexion and extension gaps. Intramedullary fixation is often required. Crucial points are: a) How to find the diaphyseal canal: It may not correspond to the center; in case of tibial diaphysis deformity the use of offset stems is recommended. 2) When are necessary stem with offset? In case of tibial diaphysis deformity the use of offset stems is recommended. 3) How to treat bone losses: Metal augments are necessary if the bone defect is greater than 10 mm.

Second step: stabilize the knee in flexion. a) Choose the size of the femoral component: It is a common mistake to measure existing bone and simply fit the corresponding femoral component to it. Often the problem in revision surgery is the bone defect on the posterior femoral condyle and a metal augment is extremely useful to avoid placing a too small component. Longer stem are recommended in cases of bone losses. In case of diaphyseal alteration, or if a translation of the component is necessary, a stem with offset can be useful. b) Seat the femoral component in external rotation: Sometimes it is not possible to use the epicondylar axis as an anatomical landmark because of the bone loss. In alternative, a sign of internal femoral rotation is the presence of a much larger amount of posterior femoral condyle in medial than in the lateral side. Using a lateral posterior metal augment can be appropriate to restore the external rotation. c) Reestablish the joint line: In the cases in which the surgeon cannot use the epycondyles as a landmark, the lower pole of the patella with the knee flexed at 90°, or the meniscal scar may be good landmarks. In cases in which the joint line has to be raised, using a tibial wedge rather than higher poly insert thickness is preferable.

Third step: stabilize the knee in extension. If the extension gap is larger than the flexion one, the femur should be distalized instead and then the polyethylene thicker increased. In the extension gap is too tight, a femoral re-cut can be performed; previous careful evaluation of patella height and collateral ligament attachments.

Results for "Revision Knee Arthroplasty"

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