Knee endoprosthesis - Aspects of operation techniques

The implantation of a condylar knee has remained a challenge for surgeons a nd the equipment of the hospital. In contrast to total hip arthroplasty, no t only is the correct insertion of the implant crucial, but also the treatm ent of the surrounding soft tissues. Mediolateral soft tissue balance and b alance between flexion and extension gaps, as well as centering the patella , have to be done carefully. The soft tissue envelope of the knee joint is thin and prone to necrosis af ter multiple incisions. Damage to the extension mechanism can make a total joint useless. Tearing the patellar ligament from the tibial tuberosity mus t therefore be avoided by all means during operation. Precise cutting of th e distal femur is only possible if excellent equipment is used by a skillfu l surgeon. The same is true for orientating saw cuts related to the long le g axes. These tasks can probably be taken over by navigation systems and robots in the future. Because the definite choice of implants has to be made intraope ratively, a complete modular system has to be present in the hospital. Only hospitals that can properly equip their surgeons to manage upcoming soft t issue problems and bony deficiencies should offer treatment to patients req uiring condylar knee arthroplasty.