BASIC CLINICAL ANATOMY AND BIO MECHANICS OF KNEE JOINT, STEP BY STEP LEARNING OF PROCEDURE OF TKR, DIAGRAMMATIC PRESENTATION

1. TOTAL KNEE REPLACEMENT
DR. D. P. SWAMI
PATIENT SELECTION
COMPREHENSIVEPREOPERATIVEWORKUP
EXTENSIVEDISCUSSIONAMONGOPERATINGTEAM
ROBUST SURGICAL TECHNIQUEDPS "ONLY FOR EDUCATIONAL PURPOSES"

2. INTRODUCTION
DPS "ONLY FOR EDUCATIONAL PURPOSES"

3. Basics of joint
DPS "ONLY FOR EDUCATIONAL PURPOSES"

4. Movers
DPS "ONLY FOR EDUCATIONAL PURPOSES"

5. Locking / unlocking
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6. Understand: Movements
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7. Understand: Movements
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8. Understand: Movements
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9. Understand: Movements
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10. Understand: Movements
DPS "ONLY FOR EDUCATIONAL PURPOSES"

11. AXIS MATTERS…MOST
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12. AXIS MATTERS…MOST
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13. IDEAL KNEE AFTER REPLACEMENT
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14. KEEP PACE WITH ROLL BACK
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15. BASIC COMPONENTS OF TKR SET
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16. POSITIONING: IN PERFACT MANNER
LATERAL SUPPORT
TOURNIQUET
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17. DRAPPING
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18. INCISION AND EXPOSURE: RESPECT SOFT TISSUES
DPS "ONLY FOR EDUCATIONAL PURPOSES"

19. MEASURE TIBIAL CUT SIZE AND CHECK
ALIGNMENT
ANKLE CLAMP
FOR TIBIAL AXIS ALIGNMENT
UP- DOWN NODE
TIBIAL SIZER
DPS "ONLY FOR EDUCATIONAL PURPOSES"

20. CHECK ALIGNMENT IN CORONAL AND
SAGITTAL PLANE
DPS "ONLY FOR EDUCATIONAL PURPOSES"

21. CHECK TIBIAL CUT SIZE BY USING
ANGEL GUIDE
DPS "ONLY FOR EDUCATIONAL PURPOSES"

22. AFTER CONFERMATION OF ALIGNMENT AND TIBIAL
CUT SIZE- FIX ZIG WITH PINS and cut with saw blade
DPS "ONLY FOR EDUCATIONAL PURPOSES"

23. Remnants of meniscus, cruciates: no mercy
• Hold meniscus with grabber for easy
manipulation
• Remove meniscus with electrocautry or
nibbler
• Remove osteophytes: it’s important
DPS "ONLY FOR EDUCATIONAL PURPOSES"

24. Femoral preparation
keep knee in flexion
Position Step Drill -
Slightly superior and medial
to the midline of trochlea
or
7 mm to 10 mm anterior to
origin of the PCL
DPS "ONLY FOR EDUCATIONAL PURPOSES"

25. Femoral preparation… Distal Femoral Resection
Set the desired valgus angle
Secure cutting block with pins
Make distal femoral cut with
fine motorized saw
DPS "ONLY FOR EDUCATIONAL PURPOSES"

26. Femoral preparation… Distal Femoral Resection
Check rotation
Make cuts:
Anterior
Posterior
Anterior chamfer
Posterior chamfer
EPICONDYLAR AXIS
WHITESIDE’S LINE
DPS "ONLY FOR EDUCATIONAL PURPOSES"

27. MIND THE GAP AND SOFT TISSUE BALANCE
To check the extension gap-
fully extend leg and place Spacer
Block between resected surfaces
NOTE:
Block should fit snugly in the
extension space
OR
Extension gap should be rectangular
Perform appropriate soft-tissue
releases to achieve balance
DPS "ONLY FOR EDUCATIONAL PURPOSES"

28. TIBAIL PREPARATION
Assess position of base to maximize
tibial coverage and avoiding overhang
The rotation of Tibial Base
is typically centered on:
junction between the medial and
central third of the tibial tubercle
DPS "ONLY FOR EDUCATIONAL PURPOSES"

29. Trial
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30. Implant insertion
DPS "ONLY FOR EDUCATIONAL PURPOSES"

31. REMEMBER THAT…..
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32. REMEMBER THAT…..
DPS "ONLY FOR EDUCATIONAL PURPOSES"

33. REMEMBER THAT…..
DPS "ONLY FOR EDUCATIONAL PURPOSES"

34. REMEMBER THAT…..
DPS "ONLY FOR EDUCATIONAL PURPOSES"

35. REMEMBER THAT…..FOR VALGUS
CORRECTION
DPS "ONLY FOR EDUCATIONAL PURPOSES"

36. REMEMBER THAT…..FOR FLEXION
DEFORMITY
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37. Thank you
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