Arthroscopic debridement of the posterior compartment of the knee after total knee arthroplasty

Abstract

Arthroscopic debridement of the posterior compartment of the knee after total knee arthroplasty is difficult because it is tough to obtain intercondylar notch views. Herein, we performed arthroscopic debridement of the posterior compartment of an infected knee after total knee arthroplasty by using a transseptal portal in a 62-year-old woman with rheumatoid arthritis. Palpation of anatomical landmarks and posterior capsule protection are important for safe creation of a transseptal portal following to making 2 posterior portals.

Figure 1

Anteroposterior (a) and lateral (b) radiographs of the patient's right knee at the first visit. No signs of infectious loosening or osteolysis around the prosthesis were detected.

Figure 2

(a) Operative procedure to determine the site of the posteromedial portal. A 22-gauge needle was inserted at the edge just posterior to the medial aspect of the femoral component. Note the drops of irrigation solution dripping from the inserted needle. (b) The black star indicates the position of the posteromedial portal. MCL: medial collateral ligament; MG: medial head of the gastrocnemius muscle; SA: sartorius; SN: saphenous nerve.

Figure 3

(a) Operative procedure to determine the site of the posterolateral portal. A 22-gauge needle was inserted at the edge just posterior to the lateral aspect of the femoral component. (b) The black star indicates the position of the posterolateral portal. BF: biceps femoris; CPN: common peroneal nerve; LCL: lateral collateral ligament; PT: popliteus tendon.

Figure 4

Arthroscopic views of the posterior compartment. The posterior septum was confirmed when viewed from the posteromedial portal (a). The septum was perforated by using a 3.0 mm Kirschner wire that was inserted from the posterolateral portal protected by a sheath (b). A 4.0 mm rod from the posterolateral portal was inserted into the initial hole created in the septum by using the Kirschner wires (c). MFC, medial condyle of the femoral component; S, septum.

Figure 5

This schema demonstrates the method to create a posterior transseptal portal. A sheath inserted from the posterolateral portal is pushed to the septum to protect popliteal vessels that lie immediately behind the lateral posterior capsule. Viewing the septum through the posteromedial portal, it is perforated first by using a 1.5 mm Kirschner wire followed by a 3.0 mm Kirschner wire through the sheath from the posterolateral portal (arrow). PM portal, posteromedial portal; PL portal, posterolateral portal; PAV, popliteal artery and vein; MCF, medial condyle of the femoral component; LCF, lateral condyle of the femoral component.

Figure 6

Arthroscopic views during debridement and synovectomy in the posterior compartment. Debridement and synovectomy in the posteromedial (a) and posterolateral (b) compartments were performed with a radiofrequency abrader that was introduced from the posterolateral (a) and posteromedial (b) portal through the posterior transseptal portal. S, septum; MCF, medial condyle of the femoral component; LCF, lateral condyle of the femoral component.