– Tibial Component Preparation: – ACL is resected, w/ or w/o PCL preservation; – Extramedullary Guides – alignment is made w/ jig parallel to ant crest of tibia shaft. – referencing was taken off the lateral tibial plateau. – Proximal Tibial Resection – Determine appropriate Posterior Slope – Depth of Tibial … Read more
– Optimize the Exposure: – it is important to fully expose the proximal tibial surface inorder to avoid iatrogenic injury to the collateral ligaments, the PCL, or even the posterior neurovascular structures; – soft tissue stripping: (see medial and lateral capsular exposure) … 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
– Discussion: – remove any accumulation of osteophytes in posterior recesses with an osteotome or rongeur; – pass a curved osteotome around each of posteior condyles, removing any overhanging bone or osteophytes; – if left unresected, this overhanging bone can impinge on tibial plastic, limiting flexion and … Read more
– Discussion: – see rotational alignment in TKR: – rotational mal-alignment may lead to patellar malalignment and varus-valgus instability; – valgus knee may have a lateral condyle which is deficient posteriorly; – therefore, use of the posterior condyles as a reference, may lead to relative internal rotation of the … 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: – Lateral Retinacular Release: – Patella in TKR; – Discussion: – this is one of the most common causes of failed knee replacement; – position of each TKR components will determine success of patellar component: – no patellar prosthesis will track correctly if the … Read more
– Discussion: – the patella should evert with minimal tension on the patella tendon; – methods to facilitate patellar eversion: – patellar resurfacing: – patellar resurfacing can be performed early in the exposure inorder to thin the patella … Read more
– See: Patella in TKR – Discussion: – indications for patellar resurfacing – patellar malalignment – lateral retinacular release – Technique: – start by everting the patella laterally and reflecting the fat pad & synovium from around its periphery; – remove any overhanging osteophytes; – limited patellar fasciectomy should be a part … 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