Extensile Exposure in Revision Total Knee Arthroplasty Using an Osteomyofascial Flap

Adequate exposure is essential for a successful revision total knee arthroplasty. A technique of approach by developing an osteomyofascial flap over the tibial tubercle is introduced in this article. Between September 1998 and August 2000, this technique was applied to assist in the surgical exposure of the knee in 22 patients undergoing revision total knee arthroplasty. When this procedure is performed, a thin bony flap is developed over the tibial tubercle and upper tibia. The overlying soft tissue including fascia, muscle, and periosteum is not disturbed during this procedure. Simple sutures were used to reattach the flap, and no special devices such as screws or wires are needed. The postoperative rehabilitation program is the same as that undertaken in primary cases. At the average follow-up time of 49 months, 21 patients have satisfactory results. This technique has the merits of its simplicity: there is no need to use a special device to fix the flap when closing the wound, the continuity of the extensor mechanism is maintained, and the normal postoperative rehabilitation program is not disturbed. Good clinical results could always be anticipated by using this technique when it is performed carefully.