1 / 17

Total Knee Arthroplasty in Varus Knee

Total Knee Arthroplasty in Varus Knee. H.Makhmalbaf MD Consultant Orthopaedic & Knee Surgeon Ghaem Hospital Medical School. The most important factor in maintaining satisfactory long-term outcome in TKA is anatomic alignment This depends significantly on ligamentous balance.

isabelle-burt
Download Presentation

Total Knee Arthroplasty in Varus Knee

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Total Knee Arthroplasty in Varus Knee H.Makhmalbaf MD Consultant Orthopaedic & Knee Surgeon Ghaem Hospital Medical School

  2. The most important factor in maintaining satisfactory long-term outcome in TKA is anatomic alignmentThis depends significantly on ligamentous balance

  3. The most favorable results are observed with femorotibial angle 3-7ovalgus , the tibial component in neutral,& the femoral component in 4-6o valgus

  4. The typical patient • Severe varus deformity • Some varus alignment since childhood • H/O medial menisectomy • Gradually progresses • Lateral subluxation of the tibia on the femur

  5. Exposure • Standard medial parapatellar arthrotomy • Resect medial meniscus • Release deep MCL • Resect ACL • Externally rotate & deliver the tibia • Remove all osteophytes

  6. Mediolateral Balancing • Ligament balance in flexion & extention are interrelated (unlike valgus knee) • In a varus knee , the knee should be balanced in extention first then in flexion

  7. Shift & resect technique • Tibia is delivered in front of the tibia • Initial conservative tibial resection • Based on the intact lateral side • 10mm lateral resection • Angle of resection is perpendicular to the long axis of the tibia & 3-5o posterior slope • Choose tibia one size smaller

  8. Shift & resect • Choose tibia one size smaller & • Shifted laterally to the edge of tibia • Align tibial rotation with tibial tubercle • Outline the nucapped portion of tibia • Free the MCL from bone • Resect bone perpedicular

  9. Formal MCL release from the tibia • Release deep MCL • Posteromedial capsule • Remove osteophytes • Release PCL • Resect PCL & put PS knee

  10. Distal femoral resection • Pre-op X-ray • Varus in the femoral shaft ? • Usually 5-7deg.cut • More resection of medial fem. condyle • The amount of resection depends on the thickness of metallic femoral component

  11. Femoral component rotation • Establish a balanced, symmetric flexion gap to maximize flex. Stability • In varus knee balance in ext.1st • Use the Whiteside line or trans epi. • 30 external rotation • Then posterior condyles in flexion

  12. Tibial bone stock deficiency • Medial tibial plateau is always deficient in varus knee • Resect enough bone not too much • Bone graft • Cement & screws • Metal wedges • Allograft

  13. Residual lateral laxity • How much laxity is acceptable • The bony alignment should not be in varus • The lateral should not gap open on the tab • Correct significant laxity • More medial release • Fibula head advancement?

  14. summary • Tibia is responsible for varus • Release MCL, remove osteopytes • Bone resection, undersize, sift • Balance flexion gap • PCL retention in severe varus? • Release PCL ? • Accept some residual laxity if • Fill bony defects in tibia

  15. Thank you

More Related