title: The peel in total knee revision: exposure in the difficult knee.
abstract: BACKGROUND
  The femoral peel to expose a difficult knee was first described by Windsor and Insall in the mid-1980s. This surgical exposure consists of a complete soft tissue subperiosteal peel of the femur. It includes the detachment of the origin of the medial and lateral collateral ligaments.
  
  
  OBJECTIVE
  We investigated the utility of a surgical exposure, the modified femoral peel, for total knee revision.
  
  
  METHODS
  We retrospectively reviewed all 101 patients who had revision TKA (132 revisions) with the femoral peel technique from January 2000 to September 2007. Of the 101 patients, three patients died, eight patients were excluded, and three patients were lost to followup. Eighty-seven patients (116 procedures) met the inclusion criteria. Outcome measures assessed included Knee Society knee score, Knee Society function score, Hospital for Special Surgery knee score, complications, and number of reoperations. The minimum followup was 2 years (mean, 3.5 years; range, 2-9 years).
  
  
  RESULTS
  Mean Knee Society knee scores improved from 47 to 85. Hospital for Special Surgery knee scores improved from 56 to 80. Quality of Well-Being and WOMAC all dimensions improved. Overall orthopaedic complication rate was 17%. Flexion contracture was improved.
  
  
  CONCLUSIONS
  This surgical approach, which results in a complete soft tissue degloving of the distal femur and proximal tibia, allowed satisfactory exposure in all cases and the complication rate related to this exposure method was comparable with other series using diverse methods of knee exposure.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Orthopaedic Institute at Mercy Hospital, 3659 S Miami Avenue, Suite 4008, Miami, FL 33133, USA. carlos@orthomercy.com
authors.forename: Carlos
authors.initials: C
authors.lastname: Lavernia
authors.forename: Juan Salvador
authors.initials: JS
authors.lastname: Contreras
authors.forename: Jose Carlos
authors.initials: JC
authors.lastname: Alcerro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005431:Florida; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000601:surgery; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome