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Preoperative Planning of TKR - “ Ä cookbook approach to TotalKnee Arthoplasty is deplorable..Dr John Insall”

Preoperative Planning of TKR - “ Ä cookbook approach to TotalKnee Arthoplasty is deplorable..Dr John Insall”. Principles of Knee replacement Surgery. Principle 1:Distal femoral valgus averages nine degrees. Prrinciple 2:Every patient’s anatomy is different.

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Preoperative Planning of TKR - “ Ä cookbook approach to TotalKnee Arthoplasty is deplorable..Dr John Insall”

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  1. Preoperative Planning of TKR-“Ä cookbook approach to TotalKnee Arthoplasty is deplorable..Dr John Insall”

  2. Principles of Knee replacement Surgery

  3. Principle 1:Distal femoral valgus averages nine degrees

  4. Prrinciple 2:Every patient’s anatomy is different

  5. Principle 3:Knee instruments were developed for aerage anatomy

  6. Principle 4:Resections from the distal femur alter ligament tension in extension whereas resections from the posterior condyles alter ligament tension in flexion

  7. Principle 5: Assymetric bone resection alter ligament balance

  8. Preoperative Radiiographs • AP weight bearing radiograph with knee in maximum extension using 14”x17”cassette • Full limb 51”study if there is previious fracture or surgery on femur • Table-down lateral view in 90degrees flexion for implant size determination

  9. Lateral Xrays show bone loss with OA mostly on tibia side and PCL contracture Lateral condlyle

  10. Templating Sequence • Define the patient’s anatomy- AP Xrays • Plan distal femoral resection- AP Xrays • Plan Tibial resection- AP Xrays • Plan posterior condyle resections- Lateral Xrays • Select femoral component size- Lateral Xrays • Plan Ligament releases- AP Xrays

  11. 1. Define the patient’s anatomy o 9 valgus o 6 varus o 7 varus Proximaltibial angle Distal femoral angle Tibiofemoral angle

  12. 2.Plan distal femoral resection-AP Xrays o 6 More bone removed from end medial Femoral condyle with six degree valgus Cut from a nine degree valgus femur

  13. 3.Plan tibia resection-AP Xray 8-10mm o 90 90 degree tibia resection On AP Xray

  14. 4.Plan posterior condylar resections-lateral Xray Equal distal and posterior cuts planned Distal cut Posterior cut

  15. 5.Select component size-lateral Xray Varus knee;use smaller condyle to Template for component size

  16. 6.Plan ligament releases- AP Xray Release of contracted medial structures will permit appropiate tensioning of the convex lateral ligaments

  17. The Valgus Knee SIX DEGREES FEMORAL RES ECTION CUTS MORE MEDIAL CONDYLE o o 15 6

  18. Medial condyle In valgus knee,template the relatively normal medial condyle

  19. The Varus Knee o 6 9mm 8mm 6 degree valgus cut Removes more bone laterally And no more than 10mm

  20. Posterior resection match distal resection and lateral condyle for templating

  21. SURGICAL PROCEDURE • Best location for femoral joint placement • Thickness of distal and posterior bone resections for optimum ligament balance • Potential need for tibia bone graft • PCL status and need for release • Need for lateral or mediial ligament release • Correct size femoral component required

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