intraoperative assessment in revision total knee arthroplasty by james a. rand, michael d. ries, g....
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/1.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/2.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/3.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/4.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/5.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/6.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/7.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/8.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/9.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/10.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/11.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/12.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/13.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/14.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/15.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/16.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/17.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/18.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/19.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/20.jpg)
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](https://reader036.vdocuments.site/reader036/viewer/2022062517/56649ee05503460f94bf02d3/html5/thumbnails/21.jpg)
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.