Beverland D. Cemented Or Non Cemented Fixation, An Issue
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The document discusses the author's experience using cemented and cementless fixation for rotating platform total knee replacements. Some key points: 1) The author's 10-year results for 600 initial cemented cases showed a survivorship of 95.6% requiring no further surgery and 97.5% having their original components, demonstrating cemented fixation works well. 2) The author then switched to cementless fixation in 1998 but saw 7 early tibial fractures in female patients with valgus alignment. Reinforcing the proximal tibia with cement or graft addressed this issue. 3) Introduction of the modified LCS Complete system in 2002 showed no revisions or complications after 5 years of follow up, representing an improvement over
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This document discusses lateral knee instability issues that can arise from weak or loose lateral structures after a knee replacement. It notes the danger of subsequent medial instability if too much of the medial plateau is resected. For knees with elongated and weak lateral structures, it recommends using the transepicondylar line as a guide and a constrained implant design for small deformities. Alternatively, a lateral condyle osteotomy could be considered. It also discusses various tibial and femoral osteotomy techniques for addressing leg alignment issues greater than 8-10 degrees. Femoral deformity corrections are noted to be more difficult due to their influence on both extension and flexion gaps.
Briard Jl. How To Correct Extra Articular Deformity. Slide 1 6
To correct deformities outside the knee joint without causing instability during a total knee replacement, the surgeon must consider both the shape of the bones and the proper alignment of the mechanical axis. The knee should be stabilized in a neutral horizontal or perpendicular joint line by aligning the prosthetic femur and tibia normally. This can be achieved by adjusting the resection of the medial femoral condyle or lateral tibial plateau to create an horizontal joint line in extension.
Hamelynck Kj. Round Table Discussion
The document discusses the history and future of total knee replacement (TKR). It describes the two main approaches in TKR design - the anatomical approach which preserves soft tissues and the functional approach which simplifies knee mechanics. While the anatomical approach aims to maintain knee function, issues with component alignment and fixation led to the functional approach. However, this resulted in high contact stresses due to incongruent surfaces. More recent mobile-bearing designs aim to allow motion while reducing stresses, but surgery is more complex. The document questions whether newer techniques like computer navigation can improve outcomes long-term.
Briard Jl. Are All Mb Knees The Same. Slide 1 28
The document discusses key design aspects of mobile bearing knees that impact stability, motion, and wear. Maximum conformity can be achieved through multi-radius or constant radius femoral designs. Motion of the bearing relative to the tibial tray can be uni-directional or multi-directional, with the latter posing higher wear risks. Stability also depends on jump height, post-cam engagement, and surgical technique. While mobile bearing knees aim to reduce wear, their mechanisms may fail over time and not all designs provide equal longevity.
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 1 18
MIS knee replacement can provide functional benefits such as faster rehabilitation, shorter hospital stays, and improved range of motion compared to traditional knee replacement. However, MIS knee replacement also has risks such as inferior component placement and revision surgery that may be higher in the initial learning curve as the surgeon gains experience with the technique. The benefits of MIS must be weighed against the potential risks.
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 1 39
The document discusses the role of computer assisted surgery (CAS) in orthopedics. It notes that CAS aims to improve implant longevity, reduce human error, and simplify surgical techniques. While CAS can increase accuracy, early systems were too troublesome with complex feedback and safety systems. The document examines studies on the benefits of CAS for total knee arthroplasty, finding it can reduce outliers but does not clearly provide better patient outcomes. Large sample sizes are still needed to detect small differences. Accuracy depends on multiple factors introducing errors. While CAS aims to benefit patients, early techniques also increased costs and surgery time. [/SUMMARY]
Primary total knee arthroplasty
Primary Total Knee Arthroplasty has evolved since the 19th century with various prosthetic designs introduced over time. Prosthetic design considerations include femoral rollback, modularity, constraint, and whether to retain or sacrifice the cruciate ligaments. Radiographs are important for preoperative planning to assess alignment and bone defects. Surgical goals include restoring mechanical alignment, joint line, balanced soft tissues, and normal patellofemoral tracking. Key steps include femoral and tibial cuts, balancing the knee in flexion and extension, and addressing any flexion contractures or deformities. Complications can include nerve palsies, vascular issues, stiffness, infections, and loosening. With careful patient selection, planning and technique, total knee
Briard Jl. Are All Mb Knees The Same. Slide 29 53
The document discusses the advantages of rotating platform mobile bearing knee replacements compared to fixed bearing designs. It notes that rotating platforms experience less backside wear and osteolysis than fixed bearings due to their unidirectional motion which reduces wear particles. Studies have shown rotating platforms have failure rates of 97.7-98.3% at 12-20 years compared to higher failure rates for mobile bearings.
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Briard Jl. How To Correct Extra Articular Deformity. Slide 41 56
Briard Jl. How To Correct Extra Articular Deformity. Slide 41 56
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 47 55
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 47 55
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 40 44
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 40 44
Hamelynck Kj. Stability Of The Knee, A Dynamic Concept
Hamelynck Kj. Stability Of The Knee, A Dynamic Concept
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 19 36
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 19 36
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 47 55
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 47 55
Briard Jl. How To Correct Extra Articular Deformity. Slide 7 14
Briard Jl. How To Correct Extra Articular Deformity. Slide 7 14
Briard Jl. How To Correct Extra Articular Deformity. Slide 15 26
Briard Jl. How To Correct Extra Articular Deformity. Slide 15 26
Briard Jl. How To Correct Extra Articular Deformity. Slide 27 40
Briard Jl. How To Correct Extra Articular Deformity. Slide 27 40
Briard Jl. How To Correct Extra Articular Deformity. Slide 1 6
Briard Jl. How To Correct Extra Articular Deformity. Slide 1 6
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 1 18
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 1 18
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 1 39
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 1 39
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Beverland D. Cemented Or Non Cemented Fixation, An Issue
- 8. Date of surgery 1: 06/01/98 2: 10/06/98 3: 12/08/98 4: 08/09/98 5: 10/09/98 6: 10/10/98 7: 19/01/01 Fractures of the proximal tibia First Last Jan 1998
- 9. Day 2 Day 5 So what had changed? Was anyone else seeing this? What were the risk factors?
- 11. Published Journal of Arthroplasty 2001; 16: 984-990
- 16. No change in femoral geometry but dimensions changed Condylar width reduced - less over hang Big Improvement Patello-femoral flange 5mm longer
- 24. Why is spinout more common in valgus knees LATERAL SIDE Slack in flexion Popliteus LCL Gastrocnemius Flexion gap Normal ligament tension
- 28. Category 1- 4 1 - Very happy 2 - Happy 3 - OK (not perfect) 4 - Never Happy So l have patients with anterior knee pain on whom I don’t re-operate!
- 29. KNEES HIPS
- 30. KNEES HIPS
- 31. KNEES HIPS
- 35. Mean Wear Rates Transactions of 50 th Annual Meeting of the Orthopaedic Research Society, Vol. 29, San Francisco, California, March 7-10 2004. Linear wear is much less than multi-directional!
- 36. Fixed bearing Multidirectional motion of femoral component relative to bearing RP Mobile bearing Bearing rotation decoupled: Linear rotation at tibial counterface with reduced rotation at femoral counterface Wear in Fixed vs Rotating Platform The LCS Rotating Platform reduces wear and cross shear by decoupling multidirectional motions to more linear motions at two interfaces