Bonutti Peter M, Seyler Thorsten M, Kester Mark, McMahon Margo, Mont Michael A
Clin Orthop Relat Res. 2006 May;446:69-75. doi: 10.1097/01.blo.0000218728.52214.ac.
Exposure in revision total knee arthroplasty can be difficult. For example, eversion of the patella may require a number of procedures including vastus snips, V-Y turndowns, and tibial tubercle osteotomies. A minimally invasive approach further adds to exposure difficulties. We report a new approach for exposure during difficult revision total knee arthroplasties. A soft tissue envelope technique allows retraction of the patella and avoids eversion. This technique reduces the size of the incision, reduces quadriceps muscle damage, and enhances exposure. It is essential that appropriate instrumentation is used along with down sized femoral and tibial cutting blocks. We report all 17 revision knee arthroplasties using this technique including unicompartmental revisions, tibial component revisions, and femoral component revisions. Followup averaged 29 months (range, 24-39 months). We had one case of posterior retained cement after a full revision with no subsequent complications. One patient required an arthroscopic lateral release for patellar maltracking. Preliminary results are encouraging using improved instrumentation we find essential for enhanced exposure. We believe this a reasonable approach for selected total knee arthroplasty revisions.
Therapeutic study, level IV (retrospective case series). See the Guidelines for Authors for a complete description of levels of evidence.
翻修全膝关节置换术中的暴露可能具有挑战性。例如，髌骨外翻可能需要多种操作，包括股直肌剪断、V-Y皮瓣翻转和胫骨结节截骨术。微创方法进一步增加了暴露的难度。我们报告一种在困难的翻修全膝关节置换术中进行暴露的新方法。一种软组织包膜技术可使髌骨回缩并避免外翻。该技术减小了切口尺寸，减少了股四头肌损伤，并增强了暴露。使用尺寸减小的股骨和胫骨截骨模块时，使用合适的器械至关重要。我们报告了使用该技术的所有17例翻修膝关节置换术，包括单髁翻修、胫骨部件翻修和股骨部件翻修。随访平均29个月（范围24 - 39个月）。在一次全翻修后有1例出现后方残留骨水泥，无后续并发症。1例患者因髌骨轨迹不良需要关节镜下外侧松解。使用我们认为对增强暴露至关重要的改进器械，初步结果令人鼓舞。我们认为这是一种针对特定全膝关节置换翻修的合理方法。
治疗性研究，IV级（回顾性病例系列）。有关证据水平的完整描述，请参见作者指南。
