Twenty consecutive patients were evaluated utilizing the suspended leg approach for MIN TKA:      Twelve female, eight male.  Patient ages ranged from 56-87, weight averaged 210 lbs (110 - 270 lbs).

The patient's leg was flexed and suspended over a table . Unique sterile draping technique and surgical heads were utilized and an incision was made two times the patellar length - 6.5-12 cm with the knee in flexion.  VMO split was utilized and the patella was retracted (not everted) laterally using special retractors to expose the joint.

Draping

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Special downsized instrumentation were used to performed extramedullary tibial and intramedullary femoral alignment with an anterior referencing system.

Tibial Cut

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Femoral Cut

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The knee was sequentially flexed and extended to expose either the tibia or the femur and allow appropriate releases. 

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Implant trailing and ligament balancing were especially enhanced in flexion allowing gravity to distract the leg to evaluate true collateral ligament balancing both in flexion / extension and through rotation.  (Note, when the leg is flexed in a traditional leg holder the posterior femur impacts against the posterior tibia and one does not obtain a true anatomic ligament balancing).

Trials

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Tricompartmental Cemented TKA

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The patella is then rotated 90° only in full extension to expose the patella for resurfacing.

Then a tricompartmental total knee replacement (Scorpio - Stryker) was cemented in position, patella tracking and ligament balancing was once again evaluated through range of motion and the knee was closed in flexion.

Incision length averaged 9 cm in extension or 12 cm in knee flexion (range 9.0-14.0 cm).  Tourniquet time averaged 55 minutes.

No exclusions were made based on preoperative ROM, contractures, stiffness, or degree of deformity.