Free your hands: an aid to tissue retraction during total knee replacement

Soft tissue retraction during Total Knee Replacement (TKR) is essential to visualise the tibial plateau. Common practice is for the assistant to use two ring holed spikes placed adjacent to either side of the tibia; this requires both hands. We describe an alternative method of soft tissue retraction, which frees the assistant to help with other aspects of the operation. Two or more pins are placed tangentially on the medial and lateral aspects of the tibia approximately 2 cm below the level of the plateau and as far apart as the soft tissues allow. The pins act as fixed retractors keeping the soft tissues out of the way (Fig. 1, Fig. 2). We have not encountered difficulties in placing the tibial jig or cementing the tibial component. Post retraction inspection of relevant soft tissues did not raise any suspicion of tissue injury. In summary fixed pin insertion during TKR is a simple and reliable method of making soft tissue retraction a hands free affair for the assistant.