Abstract
Purpose of study: To evaluate the ‘Open book’ technique (described below) for the extended approach in Total Knee arthroplasty with respect to its efficacy and outcome.
Summary: Adequete exposure in revision knee arthroplasty can be technically very demanding. Various techniques have been described to aid in exposure. These include Tibial tubercle osteotomy, V–Y quadricepsplasty, rectus snip and Patellar turn-down approach.
Since 1998 the senior author (TJW) occasionally has combined a Tibial crest osteotomy and Rectus Snip-‘Open Book Approach- in revision Knee Arthroplasty where exposure was made difficult by scarring and fibrosis.
The Tibial crest osteotomy is performed as described by Whiteside and this is combined with a 3 cm oblique Rectus snip proximally. This enables the surgeon to reflect the extensor mechanism as if opening a book. This approach protects the patellar blood supply by minimising soft tissue retraction and by making the rectus snip proximal, the feeding vessels in the quadriceps are not distributed.
Methods and Materials: Eight patients requiring Revision Knee arthroplasty in whom the ‘open book’ technique for extended approach to the Knee were reviewed for an average of 4.5 years. The patients were evaluated clinically and radiologically at final follow-up.
Results: All patients made good recovery of range of motion with little evidence of an extensor lag. There was no incidence of refracture, slippage or non-union of the osteotomy.
Conclusions: We concluded that, the ‘Open-Book’ technique is useful in the extended approach of Total Knee arthroplasty resulting in improved clinical outcome with no adverse effects.
Correspondence should be addressed to Mr Tim Wilton, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
