When looking at a knee like this, ¿what is the best incision that you should use? ¿What type of quadriceps exposure is necessary depending upon the range.

When looking at a knee like this, ¿what is the best incision that you should use? ¿What type of quadriceps exposure is necessary

depending upon the range of motion, plus or minus a synovectomy?

In preoperative planning, the history, old notes, and physical

exam are self-explanatory

Early flapping is better than late flapping. When we have a patient

who we think has compromised soft tissue, we will have a plastic surgeon

on hand to do a reconstructive procedure at the time of the

reimplantation or the revision

Multiple incisions: We are aware of using the most lateral-based incision, because of the blood supply comes from the medial

side.

If the incision is well-healed, it is 20 years old, it is mobile, it is not that deep invagination,

sometimes we will choose the more medial incision, because we can do more dissection.

Consulting the infectious disease doctor is paramount if we think an infection is

present

If flexion > 100 degrees and the revision is not extensive, we can try to do a midvastus

or subvastus approach.

The median parapatellar is probably the most commonly used

approach on both primary and revision knee arthroplasty.

A synovectomy aids in exposure. Possibly is underutilized. Getting all of the synovium out of the gutters

will help lateralization of the patella and, more importantly, avoid the

need for a lateral release

Slide the patellae laterally. That reduces the stresses across the

patellar tendon

The purpose of these enhanced exposures is to avoid extensor

mechanism disruption

You can do a beautiful knee reconstruction and if the extensor mechanism fails, then you have

quite a problem.

cut it at about a 45-degree angle into the muscular-tendinous junction

Reasonable follow-up in terms of function, pain,

and stiffness

offers great femoral exposure

•Effective in the patient who has a very stiff knee. •Prior scarring of the quadriceps mechanism.

Long tibial osteotomy, 8

to 10 cm, as thick as possible

Repair tibial tubercle

osteotomies with cerclage

wires

Arthrofibrotic kneeCollateral ligaments encased in scar