Infiltration Technique Descriptions
10
Partial Knee Arthroplasty
Injection solution includes bupivacaine liposomal injectable suspension (EXPAREL)
20 mL and 0.25% bupivacaine with epinephrine 30 mL. Normal saline 10-20 mL may
be added if extra volume is needed.
Notes:
• The femoral, saphenous and posterior tibial nerves all innervate the knee with variable
distributions. Therefore successful injection requires injecting all layers of the knee.
• Extra medication can be injected into the quadriceps tendon and proximal perisoteum,
a source of considerable patient pain, the medial meniscosynovial junction and the
patellar branch of the saphenous nerve.
• Injecting the subcutaneous layer may be omitted if the skin is very thin.
• A few mLs should be reserved for the drain site.
Infiltration Technique
Local
Analgesic
Volume
Step 1: Deep Injection of the Involved Compartment
Aer exposing the knee joint and before the prostheses are in place, inject
10 mL into the deep structures.
▶ MEDIAL UNICOMPARTMENTAL: Inject into the anterior
and posterior cruciate ligaments, the posterior medial capsule, the
superficial and deep fibers of the medial collateral ligament, the
periosteum around the cut surfaces of the medial femur and tibia,
the peri-articular synovial reflections, the suprepatellar pouch and the
medial soft-tissue envelope.
▶ LATERAL UNICOMPARTMENTAL: Inject into the lateral and
posterior popliteus, lateral and anterior iliotibial band and its insertion
on Gerdy's tubercle, and the lateral periosteum of the femur and tibia.
Inject 10 mL into the quadriceps tendon and muscles and peri-patellar
so tissue.
Note: When injecting the posterior structures avoid the midline vascular bundle.
Also avoid the peroneal nerve when injecting lateral structures.
20 mL
Step 2: Mid-layer Injection
Aer the prostheses are in place and while the cement cures, inject 10 mL
into the deep dermal tissue planes, targeting the femoral, saphenous and
posterior tibial nerve distributions.
10 mL
Step 3: Superficial Injection
e remaining 20 mL is injected into the subcutaneous layer and skin,
more medially where the sensory nerves predominate.
20 mL
