– Trial Components: – component fit: – evaluate femoral and tibial trial components and determine areas that will need additional cement; – flexion & extension gaps – range of motion: use the largest polyethylene spacer that allows full extension; … Read more
– Techique: – preparation and exposure for the proximal tibial cut: – hyperflexion of the knee to allows the vessels to fall more posteriorly; – curved knee retractors are positioned anterior to mid-coronal plane, so that patella tendon and MCL will not be injured; – inadvertent transection of the lateral patellar tendon … Read more
– See: – TKR Menu: – Medial Collateral Ligament – Lateral Collateral Ligament – Discussion: – it is not possible to make a definitive assessment of soft tissue deformity or contracture preoperatively, since joint deformity pain & muscle spasm can mask the true condition; … Read more
– See: TKR: Soft Tissue Balance and Collateral Ligaments – Discussion: – fixed varus is the most common angular contracture in pts undergoing tkr; – this deformity may be accentuated by the presence of medial tibial plateau or medial femoral condyle osteophytes; – it is essential that … Read more
– Discussion: – need to reflect capsule medially & laterally from upper 1 cm of proximal tibia; – performed circumferentially using either elevator or osteotome; – this capsular reflection relieves minor contractures and provides access for retractors to protect the posterior structures; – any rim osteophytes from the … Read more
– See: TKR Menu – Distal Femoral Resection – Distal Femoral Sizing Guide (and Rotational Alignment) – Anterior, Posterior, and Chamfer Cuts – Location of Entry Hole: – ideally the starting point is slightly medial and posterior to the center of the notch; – generally the drill needs to be inserted 1 … Read more
– Definition: – see instability following TKR – is space between the posterior coronal cut on the distal femur & transverse cut on proximal tibia, while knee is in flexion; – effect of resection of PCL (see posterior stabilized prosthesis); – in report by Kadoya, et al, effect of PCL resection … Read more
– See: – TKR Menu – Distal Femoral Resection – Femoral IM Alignment Rod – Distal Femoral Sizing Guide (and Rotational Alignment) – Anterior, Posterior, and Chamfer Cuts – Femoral Component Notching – Design Considerations: – PCL Retaining Prosthesis – Posterior Stabilized Prosthesis – left & … Read more
– Theoretical Considerations: – distance from posterior reesction plane to anterior resection plane must equal the internal dimension of femoral component being used; – this cut must be made at a distance from the anterior cut equal to inner anterior-posterior dimension of femoral component used; … Read more
– Discussion: – if there is free movement at hip, subtalar & mid-tarsal joints rotation at the knee is not essential for restricted function of prosthetic joint; – in contrast, an arthrodesed ipsilateral hip is a relative contra indication to knee replacement, for it prevents rotation of thigh as … Read more