Every picture of this section is clickable for magnifying purppose.

A CD/DVD video of the operation is available from the Stryker representatives.

Step 1

The patient is prepared for total knee replacement surgery. A leg holder or sandbag and pillar allow support of the leg for easy adjustment. A tourniquet is generally used. A medial parapatellar incision is preferred.

Step 2

The incision is made with the knee flexed to 90 degrees. It should be extended to the tibial tubercle and the capsule incised on the medial side. Care should be taken not to damage the medial meniscus during division of the synovium. The lateral flap should be released to enable the fat pad and the patella to be everted, dividing the inferior plica fold and the lateral patellofemoral synovial fold, close to the femur to avoid damage to lateral geniculate vessels. Be careful to avoid damage to the anterior meniscal and cruciate structures.

Step 3

The patella is everted laterally to expose the anterior aspect of the knee joint. The synovium around the edge of the patella is incised to define the edges. Release of the lateral retinaculum from the lateral margin of the patella and osteophyte is always required. (A peri-patella release).

Step 4

A notchplasty may be required to remove notch osteophytes, and the integrity of the cruciate ligaments confirmed. The index finger is inserted into the notch to ensure a smooth arch and adequate space for the cruciate ligaments. The anterior aspect of the femur should be exposed by incision of the anterior synovium of the supra patella pouch. The flaps are elevated to get a good view of the anterior cortex of the femur.