Die Extension-First-Technik bei der Knie-TEP-Implantation

Objective

Surgical technique in total knee arthroplasty (TKA) to combine the femur first and tibia first techniques in order to reduce surgical mistakes regarding rotation and alignment.

Indications

Symptomatic arthritis of the knee.

Contraindications

General contraindications for TKA.

Surgical technique

Osseous preparation starting with a distal femur cut. Then the proximal tibia cut is accomplished and the knee is balanced in extension after checking for correct alignment. Bone-referenced positioning of the femoral cutting block for further preparation of the femur. Finally, the rotation of the femur is checked in 90° of flexion by means of ligament tension. If required, the rotation is checked and the flexion gap balanced, respectively.

Postoperative management

Mobilization with weight bearing and range of motion as tolerated.

Results

In a prospective study, 267?knees (160 women, 107 men, average age of 69.3 [46?C89]?years) were followed up preoperatively and after 6 weeks. The clinical results were based on the American Knee Society score. The scores were 48.9 (32?C68) preoperatively and 86.5?(75?C100) at follow-up. Radiologically 92.1% of the knees showed a malposition <3°.