Surgical Approaches

  • Ermanno A. Martucci


Modern reconstructive surgery of the knee is the consequence of about 25 years of experience. The continuous progress made in the different fields of surgery, the design of prosthetic components, and the technology of biomaterials have, in fact, led to excellent clinical and radiographic medium-term results. Like for any surgical procedure, exposure of the anatomical structures in knee replacement surgery must be sufficiently wide, taking into consideration the fact that the periarticular tissues must be “treated” with great accuracy. In fact, the knee is relatively superficial as compared to the hip, which is the other joint most commonly submitted to reconstructive surgery; consequently, the tissues surrounding it are characterized by minor extension, Thus, when this type of surgery is approached, the risk of skin complications, particularly necrosis, must not be overlooked, as they may influence the very survival of the prosthetic implant itself. The incision must be sufficiently long, and at any rate easily extendable in a proximal and distal direction, to allow for the adequate visualization of the anatomical structures involved, but also to avoid excessive tension on the soft tissues. Particular care must be taken when there are previous skin incisions. Transverse ones made, for example, in meniscectomy or tibial osteotomy, are safely transected at a right angle. Vertical ones must possibly be incorporated in the new incision; if the contrary should occur, the latter must be sufficiently distant (at least 7 cm) from the previous one. When multiple longitudinal parallel incisions are present, the lateral one is to be preferred. In patients with multiple scars and adherent skin a “sham” incision is a good option; if after 3 weeks normal healing occurs, the definitive knee arthroplasty procedure may be performed. Furthermore, when planning the skin incision, the surgeon must not overlook the fact that a new operation may be required in the future.


Total Knee Arthroplasty Patellar Tendon Tibial Tubercle Quadriceps Tendon Valgus Knee 
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© Springer-Verlag Wien 2001

Authors and Affiliations

  • Ermanno A. Martucci
    • 1
  1. 1.Rizzoli Orthopaedic InstituteBologna

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