Protesis de rodilla

1. HOSPITAL II CHOCOPE
PLANIFICACION PREOPERATORIA PROTESIS TOTAL
DE RODILLA
ELMER JESUS NARVAEZ RODRIGUEZ
MR2 TRAUMATOLOGIA Y ORTOPEDIA

2. INDICACIONES
• Artritis severa (RA, OA, etc.) que causa dolor
significativo, discapacidad y restricción (gonartrosis
avanzada grado III–IV)
Considerar la esperanza de vida y las expectativas de
los pacientes
Deformidad importante
Tricompartimental
Unicompartimental (afectación unicompartimental
adultos y jóvenes)
• CAMPBELL-CIRUGIA ORTOPEDICA. S TERRY CANALE, JAMES H BEATY

3. OSTEOARTHRITIS

4. RHEUMATOID
ARTHRITIS

5. CONTRAINDICACIONES:
Local or general sepsis
Neuropathic joints
Arthrodesed joints?
Poor skin coverage
Lack of muscle control
Inability to co-operate post operatively
• CAMPBELL-CIRUGIA ORTOPEDICA. S TERRY CANALE, JAMES H BEATY

6. Pre-Op Evaluation
• A) History
• B) Local Examination & assessment
• C) Investigations
• D) X-rays: AP (standing)
Lateral
Long leg films
Pelvis
• E) Special tests
• CAMPBELL-CIRUGIA ORTOPEDICA. S TERRY CANALE, JAMES H BEATY

7. HISTORIA CLINICA
Dolor de rodilla - debe diferenciarse
del dolor de cadera referido
Excluir la claudicación vascular /
neurológica periférica
Enfermedad concurrente, historia
relevante, medicamentos, alergias,
cirugías anteriores y anestésicos
previos
• CAMPBELL-CIRUGIA ORTOPEDICA. S TERRY CANALE, JAMES H BEATY

8. CARACTERISTICAS DEL
DOLOR
_Características del dolor - inicio del dolor; gravedad;
duración; afectar el funcionamiento; dolor nocturno;
detección, captura o bloqueo notables;
_Tratamientos previos (farmacológicos, físicos y terapia
ocupacional)
_Cirugías anteriores
_También discuta pasatiempos del paciente, ocupación y
metas del tratamiento

9. High risk factors for
infection
Pat Patient Related:
• Immuno-compromised ( RA, Diabetes,
Steroid use, Advanced age etc. )
• Wound healing problems
• Obesity
• UTI
• Dental procedures

10. Local examination
• Gait analysis
Antalgic gait – knee arthritis
Knee thrust gait – ligament instability
Trendelenburg gait – hip pain
• Skin analysis
Signs of infection, including swelling
and rubor
Scars indicating previous operations
Any other lesions in the surgical area

11. Local examination
• Look for gross deformities
Varus
Valgus
Recurvatum
Flexion
• Effusion
• Patellar tracking
• Palpate dorsalis pedis (DP)
artery and posterior tibial
(TP) artery

12. Local examination
• Range of motion
• Ligament instability
• Hip examination
• Knee examination

13. Radiographic planning – why?
• Every patient anatomy is
different
• Bone resection from
distal femur – alter gap
in extension
• Bone resection from
proximal femur – alter
gap in flexion and
extension

14. Radiographic
planning
• AP weight bearing
radiographs in maximum
extension
• Ideally full length standing
scanogram (HKA)
• Lateral view in 90o flexion –
for assessment of implant size
• Every patient anatomy is
different

15. Lateral radiographs -
importance
Reveal
• Posterior osteophytes
• Bone loss on tibia
• PCL contracture
• Loose bodies
• Patello-femoral
osteoarthritis

17. Investigations -
• All routine blood investigations
• Especially Hb – need for blood arrangement, post op
transfusion
• S. Creatinine – will guide use of post op analgesia
• PT/aPTT/INR
• Urine routine – to rule out occult infection
• Specialist consultation (as per pt needs)
Endocrinology – DM, hypothyroidism
Cardiology
Nephrology

18. 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 release – AP X rays

19. Planning of skin incision in
previous scars
• Avoid flaps &
undermining of skin
particularly laterally over
patella
• Old incisions of prior
menisectomy, which are
either oblique or behind
the midline, can be
ignored.

20. Planning of skin incision
in previous scars
• Cross transverse incisions at 90°.
• Include recent parapatellar
incisions in main incision if
practical.
• Use most lateral longitudinal
incision if it will allow adequate
access

21. • CAMPBELL-CIRUGIA ORTOPEDICA.S
TERRY CANALE, JAMES H BEATY

37. GRACIAS