Document Detail

The peel in total knee revision: exposure in the difficult knee.
MedLine Citation:
PMID:  20574805     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The femoral peel to expose a difficult knee was first described by Windsor and Insall in the mid-1980s. This surgical exposure consists of a complete soft tissue subperiosteal peel of the femur. It includes the detachment of the origin of the medial and lateral collateral ligaments.
QUESTIONS/PURPOSES: We investigated the utility of a surgical exposure, the modified femoral peel, for total knee revision.
METHODS: We retrospectively reviewed all 101 patients who had revision TKA (132 revisions) with the femoral peel technique from January 2000 to September 2007. Of the 101 patients, three patients died, eight patients were excluded, and three patients were lost to followup. Eighty-seven patients (116 procedures) met the inclusion criteria. Outcome measures assessed included Knee Society knee score, Knee Society function score, Hospital for Special Surgery knee score, complications, and number of reoperations. The minimum followup was 2 years (mean, 3.5 years; range, 2-9 years).
RESULTS: Mean Knee Society knee scores improved from 47 to 85. Hospital for Special Surgery knee scores improved from 56 to 80. Quality of Well-Being and WOMAC all dimensions improved. Overall orthopaedic complication rate was 17%. Flexion contracture was improved.
CONCLUSIONS: This surgical approach, which results in a complete soft tissue degloving of the distal femur and proximal tibia, allowed satisfactory exposure in all cases and the complication rate related to this exposure method was comparable with other series using diverse methods of knee exposure.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Carlos Lavernia; Juan Salvador Contreras; Jose Carlos Alcerro
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-01-25     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  146-53     Citation Subset:  AIM; IM    
Orthopaedic Institute at Mercy Hospital, 3659 S Miami Avenue, Suite 4008, Miami, FL 33133, USA.
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MeSH Terms
Aged, 80 and over
Arthroplasty, Replacement, Knee / adverse effects,  instrumentation,  methods*
Femur / radiography,  surgery*
Joint Instability / etiology,  surgery
Knee Joint / physiopathology,  radiography,  surgery*
Knee Prosthesis
Medial Collateral Ligament, Knee / surgery
Middle Aged
Prosthesis Design
Prosthesis Failure
Prosthesis-Related Infections / etiology,  surgery
Range of Motion, Articular
Recovery of Function
Retrospective Studies
Time Factors
Treatment Outcome

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