An Algorithmic Approach to Exposing the Stiff Total Knee Arthroplasty

With an expanding volume of primary and revision knee arthroplasty cases, techniques to successfully navigate the challenges of a complex operation are necessary. Adequate exposure is needed to execute the planned arthroplasty. An algorithmic approach should be utilized to assist in the exposure of knees with a limited range of motion. This approach offers a stepwise sequence, with successive maneuvers indicated by the need for further exposure: medial parapatellar arthrotomy with wide synovectomy, quadriceps snip, then tibial tubercle osteotomy. The V-Y turndown, femoral peel, and "banana peel" are historical techniques not routinely utilized as part of the exposure sequence.