Della Valle Cj

Surgical exposures in revision total knee arthroplasty

Safely obtaining adequate exposure at the time of revision total knee arthroplasty is an integral step in successfully performing the procedure. A medial capsular approach combined with an extensive intraarticular synovectomy provides adequate exposure for most patients. If further exposure is required, a quadriceps snip can be used to free the proximal extensor mechanism. The benefits of this approach include its technically simple nature and an unaltered postoperative rehabilitation regimen. We report a series of 126 consecutive revision knee procedures in which a medial capsular approach was adequate in 111 cases, representing 92% of the patients with an intact extensor mechanism. A quadriceps snip was required in nine cases. If more extensive exposure is required for an excessively stiff or difficult to expose knee, a tibial tubercle osteotomy or V-Y quadricepsplasty provides wider exposure.Level of Evidence: Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Periprosthetic joint infection: modern aspects of prevention, diagnosis, and treatment.

Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) is a devastating complication. Despite improvements in our understanding of PJI, the prevalence of this complication has not decreased in recent years, with various authors reporting rates of 1 to 2% after primary TJA and up to 7% following revision TJA. While the volume of publications, symposiums, and presentations on PJI is vast, controversy still remains regarding the prevention, diagnosis, and treatment of patients with PJI. The purpose of this article is to provide a succinct summary of the recent literature on the diagnosis, treatment, and prevention of a PJI after TJA.