Medial Collateral Ligament Release Facilitates Exposure in Revision Total Knee Arthroplasty

Abstract

Incidence of revision total knee arthroplasty is growing. Revision surgery aims at preserving the collateral ligaments to minimize implant constraint and stress on the implant-cement-bone interface. Exposure in the stiff knee can be challenging as a result of loss of soft tissue elasticity and capsular scarring brought on by multiple surgeries. If a quadriceps snip does not provide adequate visualization a quadriceps turndown or a tibial tubercle osteotomy is recommended to improve exposure. Such extensile approaches have various limitations and might risk compromising the extensor mechanism, recovery time, bone fixation, or wound healing. The current case report describes a novel technique to combine a quadriceps snip with cutting the medial collateral ligament to gain exposure. While patients require a hinged implant, the integrity of the extensor mechanism is preserved. This allows for immediate active and passive range of motion and places this approach at an advantage over a quadriceps turndown or tibial tubercle osteotomy.

Keywords

exposure - revision total knee arthroplasty - orthopedic surgery - knee arthroplasty

• References

• 1 Barrack RL, Smith P, Munn B, Engh G, Rorabeck C. The Ranawat Award. Comparison of surgical approaches in total knee arthroplasty. Clin Orthop Relat Res 1998; (356) 16-21
• 2 Meek RM, Greidanus NV, McGraw RW, Masri BA. The extensile rectus snip exposure in revision of total knee arthroplasty. J Bone Joint Surg Br 2003; 85 (8) 1120-1122
• 3 Younger AS, Duncan CP, Masri BA. Surgical exposures in revision total knee arthroplasty. J Am Acad Orthop Surg 1998; 6 (1) 55-64
• 4 Jacofsky DJ, Della Valle CJ, Meneghini RM, Sporer SM, Cercek RM ; American Academy of Orthopaedic Surgeons. Revision total knee arthroplasty: what the practicing orthopaedic surgeon needs to know. J Bone Joint Surg Am 2010; 92 (5) 1282-1292
• 5 Engh GA. Exposure options for revision total knee arthroplasty. In: Bono JV, Scott RD, , eds. Revision Total Knee Arthroplasty. New York, NY: Springer; 2005: 63-75
• 6 Whiteside LA, Ohl MD. Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res 1990; (260) 6-9
• 7 Whiteside LA. Exposure in difficult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res 1995; (321) 32-35
• 8 Jones LC, Hungerford DS. Cement disease. Clin Orthop Relat Res 1987; (225) 192-206
• 9 Rand JA, Chao EY, Stauffer RN. Kinematic rotating-hinge total knee arthroplasty. J Bone Joint Surg Am 1987; 69 (4) 489-497
• 10 Jones RE, Skedros JG, Chan AJ, Beauchamp DH, Harkins PC. Total knee arthroplasty using the S-ROM mobile-bearing hinge prosthesis. J Arthroplasty 2001; 16 (3) 279-287
• 11 Barrack RL. Evolution of the rotating hinge for complex total knee arthroplasty. Clin Orthop Relat Res 2001; (392) 292-299
• 12 Deehan DJ, Murray J, Birdsall PD, Holland JP, Pinder IM. The role of the rotating hinge prosthesis in the salvage arthroplasty setting. J Arthroplasty 2008; 23 (5) 683-688
• 13 Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am 2007; 89 (8) 1735-1741
• 14 Hernández-Vaquero D, Sandoval-García MA. Hinged total knee arthroplasty in the presence of ligamentous deficiency. Clin Orthop Relat Res 2010; 468 (5) 1248-1253