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Implant Removal In Revision Total Knee Arthroplasty (TKA): Tips And Tricks

February 19, 2016

Contributors: Federica Rosso, MD; Davide E Bonasia, MD; Umberto Cottino; Federico Dettoni, MD; Matteo Bruzzone, MD; Roberto Rossi, MD

In the video, we focus not only on the implant removal, but also on to some tips and tricks useful in more complex cases. For a safe removal a good exposure is needed. In cases of stiff knee, difficult exposure or severe patella dysfunction, an osteotomy of the tibial tubercle may be useful. To remove the implant the aim should be to preserve as much bone as possible, and the surgeons may need specific instrumentation. A kind of "steps technique" can be useful approaching an implant removal, as following: 1) The first step is to remove the poly liner, which allows increasing the space for the further steps. Small osteotomes can be used to remove a standard poly insert. If a hinged poly has to be removed, depending on the locking mechanism, small osteotomes or specific instrumentation are needed. 2) The second component to remove is the femur. The implant-cement or implant-bone interface is indentified. The femur is approached from the medial to the lateral side, starting from the anterior flange and going to the posterior condyle. Be careful to maintain a parallelism between the saw and the interface, to avoid removal of unwanted bone. Once the interface is completed with the power saw, the osteotomes can be used to mobilize the femoral component. In case of stemmed implants a specific instrumentation may be useful, and an anterior cortical window may be performed to remove the residual cement. 3) The last step is to remove the tibial component. The target surface is approached using oscillating saw from the anterior aspect to the postero-medial corner, being careful not to damage the surrounding soft tissue. Then, the lateral side can be approached using smaller saws. After the entire tibial platform is completed, stacking broad osteotomes can be used to detach the component. 4) Removal of the patellar component should be attempted after thoughtful consideration, because of the risk of fracture. The use of osteotomes is discouraged because of the fracture risk. In conclusion, the first step for a safe implant removal is to obtain a good exposure. The removal should begin from the poly liner to allow better exposition for the further steps. In case of cemented stems, an anterior cortical window can be useful to allow complete removal. Finally the patella component removal should be carefully planned because of the risk of patella fracture.

Results for "Revision Knee Arthroplasty"

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