Le vie d’accesso alla riprotesizzazione del ginocchio

Total knee arthroplasty is nowdays a safe and reliable procedure in order to pain relief and restore function. Despite the good outcomes in long-term follow-up, the changing in demographics and the growing of surgical procedures, will increase the number of revisions. During the approach to total knee revision, the exposure is often the first issue, which must be addressed step by step. Skin incision must be decided according to previous scars or to varus/valgus deformity. Knee joint can be exposed firstly from a standard medial/lateral parapatellar approach. After scar tissue removal, if the exposure is not sufficient, or the risk of patellar tendon rupture is serious, an extensile approach is necessary. Quadriceps snip is usually the first approach performed, because of the possibility of safe patellar eversion without extensor mechanism interruption or vascular damage. Quadriceps turndown provides to a wide joint exposure, using a “V-Y” plasty of the quadriceps tendon. Tibial tubercle osteotomy (TTO) consists in the osteotomy of a bone fragment containing anterior tibial tubercle and patellar tendon, and subsequent eversion. Both quadriceps turndown both TTO are challenging procedures, and the choice of this kind of exposure must be weighed according to proper indications and potential pitfalls.