Transcript
Page 1: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Intraoperative Assessment in Revision Total Knee Arthroplasty

by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas

J Bone Joint Surg AmVolume 85(suppl 1):S26-S37

January 1, 2003

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

The vascular anatomy of the knee skin.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Vascular supply to the skin is through the subdermal plexus.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Figs. 3-A and 3-B Gastrocnemius myocutaneous flap used in prophylactic staged reconstruction.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Healed flap prior to total knee arthroplasty.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

FIgs. 4-A, 4-B, and 4-C Saphenous fasciocutaneous flap used to reconstruct skin, the patella, and the extensor tendon for knee arthrodesis and limb salvage.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Flap.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Flap placed.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

FIgs. 5-A, 5-B, and 5-C Anterolateral thigh free flap used to treat skin compromise and chronic infection.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Flap at the time of removal of the antibiotic spacer.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 11: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Healed wound.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 12: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

A quadriceps snip consists of an oblique incision across the rectus femoris tendon in a proximal-lateral direction.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 13: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

The V-Y quadricepsplasty consists of an oblique incision across the rectus femoris tendon in a distal-lateral direction, which can be closed as a Y, lengthening the tendon.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 14: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

The bone cut (A) and the exposure achieved and wire placement for closure (B) for the tibial tubercle osteotomy.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 15: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

The medial epicondylar osteotomy.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 16: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Intraoperative view of a tibial defect after débridement of an osteolytic defect and preparation of bone cuts.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 17: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Morselized allograft is packed around the tibial stem to fill the defect.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 18: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Type-III bone defect following implant and cement removal.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 19: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Structural femoral allograft prepared for revision.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 20: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Distal femoral allograft fixed with cables.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.

Page 21: Intraoperative Assessment in Revision Total Knee Arthroplasty by James A. Rand, Michael D. Ries, G. H. Landis, Aaron G. Rosenberg, and S. Haas J Bone Joint

Morselized allograft in cavitary bone defects.

James A. Rand et al. J Bone Joint Surg Am 2003;85:S26-S37

©2003 by The Journal of Bone and Joint Surgery, Inc.


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