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An Algorithmic Approach to Exposing the Stiff Total Knee Arthroplasty
Lohith Vatti1, Giles R Scuderi1
1Department of Orthopaedic Surgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Northwell Orthopaedic Institute, 1001 Franklin Avenue, Garden City, NY 11530, USA.
The Orthopedic Clinics of North America
|March 19, 2026
Summary
Navigating complex knee arthroplasty requires an algorithmic approach for optimal exposure, especially in stiff knees. This method prioritizes sequential maneuvers like arthrotomy and osteotomy for better surgical access.
Area of Science:
- Orthopedic Surgery
- Surgical Techniques
Background:
- Increasing complexity and volume of primary and revision knee arthroplasty cases.
- Need for effective strategies to manage challenging surgical exposures.
- Limited range of motion in knees presents significant exposure difficulties.
Purpose of the Study:
- To present an algorithmic approach for optimizing surgical exposure in knee arthroplasty.
- To provide a stepwise method for managing knees with limited range of motion.
- To outline a sequence of maneuvers for achieving adequate surgical access.
Main Methods:
- Development of a stepwise algorithmic approach for knee arthroplasty exposure.
- Sequential application of maneuvers based on the degree of exposure needed.
- Key steps include medial parapatellar arthrotomy with synovectomy, quadriceps snip, and tibial tubercle osteotomy.
Main Results:
- The algorithmic approach provides a structured method for challenging knee exposures.
- Successive maneuvers are indicated by the progressive need for greater exposure.
- Historical techniques like V-Y turndown are noted as not routinely used in this sequence.
Conclusions:
- An algorithmic approach is essential for managing complex knee arthroplasty exposures.
- The proposed sequence of maneuvers effectively addresses limited range of motion.
- This strategy aids surgeons in achieving adequate exposure for successful knee replacement procedures.
