Extensile Exposure Options: Exposing the Stiff Knee in Total Knee Arthroplasty

Adequate surgical exposure is one key to successful total knee arthroplasty. The approach selected is dependent on surgeon knowledge and experience, individual patient anatomy, and location of prior surgical incisions. This article summarizes various exposure techniques, and then describes and illustrates the author's preference for exposure of the difficult knee—tibial tubercle osteotomy. This procedure allows exposure without radical undermining of the soft tissues. Steps for extended intraosseous tibial exposure are described for revision total knee arthroplasty cases that require even more exposure. The use of vascularized soft-tissue flaps is also described to ensure adequate wound closure.