Challenge of the Week / Knee / 06.25.2021

An 80-year-old male patient undergoes a revision left total knee arthroplasty for aseptic loosening of the tibial component. The index procedure used a regular keel on the tibial component. Preoperative lateral radiographs showed poor bone stock anterior to the tibial component. Which of the following operative approaches that will not require modification of postoperative rehabilitation should be used for the best exposure?
    • Standard medial parapatellar approach
    • A standard medial parapatellar approach can be used for standard exposure to a total knee revision; however, it is limited. A standard medial parapatellar approach can be easily converted to a quadriceps snip to increase exposure.
    • Quadriceps snip
    • A quadriceps snip can be used to improve exposure. It involves cutting across the quadriceps tendon at an angle of 45° from distal to proximal into the vastus lateralis. It does not require any change to postoperative protocol or rehabilitation.
    • Tibial tubercle osteotomy (TTO)
    • A TTO is contraindicated here secondary to the poor bone stock anterior to the tibial component. This can lead to fracture or nonunion of the osteotomy site. A regular keel was used on the primary component, so removing the tubercle is not required for prosthesis removal.
    • Patellar tendon peel
    • A patellar tendon peel involves releasing the proximal aspect of the patella tendon from the tubercle to increase mobilization of the patella.


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