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.
Level of evidence: Therapeutic study, level IV (retrospective case series). See the Guidelines for Authors for a complete description of levels of evidence.