Seven specialized exposures for revision hip and knee replacement.

With the increasing rates and complexity of revision hip and knee arthroplasty, it has become more important than ever to approach the joint in a safe and rational manner. The development of extensile approaches have significantly simplified the removal of solidly fixed components without compromising bone stock. The extended trochanteric osteotomy enables controlled access to the femoral component and is a useful technique for revision of solidly-fixed femoral components. The trochanteric slide allows comprehensive exposure of the acetabulum and femur comparable to trochanteric osteotomy with a diminished risk of trochanteric escape. The vastus slide allows wide exposure of the femoral shaft when using an anterolateral approach. In revision total knee arthroplasty, the extensor mechanism is often at risk of disruption or avulsion, and in most cases, maneuvers that allow wide exposure of the femur and tibia while preserving the extensor mechanism are essential. Such exposures include one of the extensor mechanism reflecting techniques either proximally by rectus snip or patellar turndown, or distally by tibial tubercle osteotomy. Occasionally a femoral peel or epicondylar osteotomy is required. There should be a low threshold to consider one of these specialized approaches during revision hip and knee arthroplasty.