SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 47 55Struijs
This document discusses techniques for high tibial osteotomy (HTO) and the potential role of computer-assisted orthopedic surgery (CAOS) in improving HTO. It notes various HTO techniques including closing-wedge, opening-wedge, and dome osteotomies. It states that navigation aids (NAV) could enhance HTO and that CAOS may simplify the procedure over time as the technology improves, though surgical experience remains important and CAOS is currently best used in specialized centers given its complexity.
Hamelynck Kj. Stability Of The Knee, A Dynamic ConceptStruijs
This document discusses the stability of the normal knee and how it is affected by total knee replacement. The normal knee has intrinsic stability from its geometry and menisci, as well as extrinsic stability from ligaments, capsules, and muscles. It demonstrates rotations and translations during motion. Total knee replacement removes articular surfaces and cruciate ligaments, destabilizing the knee. Without properly functioning ligaments after surgery, the knee loses proprioceptive feedback and the range of passive motion increases, disturbing dynamic stabilization. To create good stability, the collateral ligament frame must be maintained without additional releases.
Briard Jl. How To Correct Extra Articular Deformity. Slide 41 56Struijs
The document discusses surgical correction of medial laxity and malalignment in a patient's knee through multiple procedures. It recommends performing an intra-articular surgery like a total knee arthroplasty first to address instability before conducting an osteotomy to address alignment. The osteotomy should be planned carefully based on preoperative templates and imaging to fully correct deformities while avoiding complications from the additional surgery.
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 40 44Struijs
This surgical procedure involves reaming the acetabulum, inserting a cup, and adjusting leg length and offset before final reduction to allow examination of flexion, extension, rotation ranges of motion.
The document summarizes discussions from a 2007 conference on knee arthroplasty that took place 10 years prior in 1997. Speakers debated whether posterior stabilization is needed during knee replacement surgery, with one speaker saying there is little need to preserve the posterior cruciate ligament, while another preferred posterior stabilization. A third speaker joked that Moses said to not resect the posterior cruciate ligament. When asked if residents performed the surgeries, one speaker said surgeons give residents the idea that they are performing the operation. Another speaker compared mobile bearing knee replacements to giving a Ferrari but only allowing 60 mph speeds.
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 47 55Struijs
This document discusses techniques for high tibial osteotomy (HTO) and the potential role of computer-assisted orthopedic surgery (CAOS) in improving HTO. It notes various HTO techniques including closing-wedge, opening-wedge, and dome osteotomies. It suggests that navigation aids (NAV) could enhance HTO. It acknowledges that CAOS may simplify and improve HTO but cautions that the technique is demanding and should only be used in specialized centers with experienced surgeons, as high-tech tools cannot replace surgical skill and experience.
Beverland D. Cemented Or Non Cemented Fixation, An IssueStruijs
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
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 47 55Struijs
This document discusses techniques for high tibial osteotomy (HTO) and the potential role of computer-assisted orthopedic surgery (CAOS) in improving HTO. It notes various HTO techniques including closing-wedge, opening-wedge, and dome osteotomies. It states that navigation aids (NAV) could enhance HTO and that CAOS may simplify the procedure over time as the technology improves, though surgical experience remains important and CAOS is currently best used in specialized centers given its complexity.
Hamelynck Kj. Stability Of The Knee, A Dynamic ConceptStruijs
This document discusses the stability of the normal knee and how it is affected by total knee replacement. The normal knee has intrinsic stability from its geometry and menisci, as well as extrinsic stability from ligaments, capsules, and muscles. It demonstrates rotations and translations during motion. Total knee replacement removes articular surfaces and cruciate ligaments, destabilizing the knee. Without properly functioning ligaments after surgery, the knee loses proprioceptive feedback and the range of passive motion increases, disturbing dynamic stabilization. To create good stability, the collateral ligament frame must be maintained without additional releases.
Briard Jl. How To Correct Extra Articular Deformity. Slide 41 56Struijs
The document discusses surgical correction of medial laxity and malalignment in a patient's knee through multiple procedures. It recommends performing an intra-articular surgery like a total knee arthroplasty first to address instability before conducting an osteotomy to address alignment. The osteotomy should be planned carefully based on preoperative templates and imaging to fully correct deformities while avoiding complications from the additional surgery.
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 40 44Struijs
This surgical procedure involves reaming the acetabulum, inserting a cup, and adjusting leg length and offset before final reduction to allow examination of flexion, extension, rotation ranges of motion.
The document summarizes discussions from a 2007 conference on knee arthroplasty that took place 10 years prior in 1997. Speakers debated whether posterior stabilization is needed during knee replacement surgery, with one speaker saying there is little need to preserve the posterior cruciate ligament, while another preferred posterior stabilization. A third speaker joked that Moses said to not resect the posterior cruciate ligament. When asked if residents performed the surgeries, one speaker said surgeons give residents the idea that they are performing the operation. Another speaker compared mobile bearing knee replacements to giving a Ferrari but only allowing 60 mph speeds.
SøRen Toksvig Larsen. The Role Of Cas (Computer Assisted Surgery). Slide 47 55Struijs
This document discusses techniques for high tibial osteotomy (HTO) and the potential role of computer-assisted orthopedic surgery (CAOS) in improving HTO. It notes various HTO techniques including closing-wedge, opening-wedge, and dome osteotomies. It suggests that navigation aids (NAV) could enhance HTO. It acknowledges that CAOS may simplify and improve HTO but cautions that the technique is demanding and should only be used in specialized centers with experienced surgeons, as high-tech tools cannot replace surgical skill and experience.
Beverland D. Cemented Or Non Cemented Fixation, An IssueStruijs
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
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 19 36Struijs
The document discusses several topics related to minimally invasive knee replacement surgery including:
1. Functional outcomes tend to be similar to traditional knee replacements but with less flexion and quadriceps avoidance.
2. Computer navigation can improve alignment accuracy but does not provide clear functional benefits.
3. Controversy exists around whether smaller incisions actually provide benefits or increased risks compared to standard incisions. Pain management is important for recovery.
Briard Jl. How To Correct Extra Articular Deformity. Slide 7 14Struijs
The document discusses deformities of the knee and their correction during total knee arthroplasty. For genu varum, which is primarily a tibial deformity, correcting the tibial joint line from oblique to perpendicular with a medial release is sufficient. For genu valgum femur, the femoral joint line needs to be reoriented from oblique to horizontal through lateral release and compensating for bone missing from the lateral condyle by adjusting the femoral component rotation. Flexion gap can be maintained by releasing the medial collateral ligament and elongating it.
Briard Jl. How To Correct Extra Articular Deformity. Slide 1 6Struijs
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.
Briard Jl. How To Correct Extra Articular Deformity. Slide 27 40Struijs
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.
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. How To Correct Extra Articular Deformity. Slide 15 26Struijs
The document discusses surgical techniques for dealing with extra-articular deformities in total knee arthroplasty (TKA). It notes that lateral collateral ligament release for femoral varum is difficult and risks postoperative instability, while medial release is safer. It recommends intra-articular correction of extra-articular deformity over extra-articular procedures. For femoral varum, it suggests medial release, lateral condyle resection, femoral rotation in internal rotation, or a medial condylar osteotomy. For tibial valgum, it recommends a lateral collateral ligament release.
Briard Jl. Are All Mb Knees The Same. Slide 1 28Struijs
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.
Jennings Lm. Wear Of Knee Replacements Influence Of Kinematics And DesignStruijs
The document discusses factors that influence wear in knee replacements, including prosthesis design and kinematics. It finds that rotating platform mobile bearing knee replacements significantly reduce wear and osteolytic potential compared to fixed bearing knees, but some of these benefits can be lost if lift-off of the femoral condyle occurs, increasing medial/lateral wear in both designs. Careful surgery and soft tissue management are important to wear performance. Rotating platform mobile bearing knees showed a four-fold reduction in wear rate compared to fixed bearing knees in simulated tests.
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 1 18Struijs
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 39Struijs
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]
This document discusses the evolution and design of total knee arthroplasty (TKA). It describes how early TKA designs in the 1970s-1980s led to improved designs that better replicated normal knee biomechanics. The key developments included posterior cruciate ligament retaining versus substituting designs, improved patellofemoral tracking, and converting flexion-extension gaps. The document outlines the surgical technique for TKA, including approaches, bone cuts, ligament balancing, and the goals of restoring alignment and stability while maximizing range of motion.
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 53Struijs
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.
Hässleholm and Vaggeryd. Två svenska exempelLo Claesson
About cooperation with social services in Hässlholm, makerspace in Vaggeryd and both libraries' adaption to the Danish Four Room Model. This presentation was made for library staff on Greenland.
Tankar kring "Framtidens barnbibliotek" framtagna av Nätverket för barnbiblioteksverksamhet i Kalmar län 2009-2010. Sammanställt av Pia Malmberg-Kronvall, Regionbiblioteket i Kalmar län
Löken och albatrossen Trollhättan Uddevalla 11-12 juni 2018Peter Alsbjer
Jag var och föreläste om fram- och samtidens folkbibliotek i Trollhättan och Uddevalla häromdagen. Här ät presentationen jag använde mig av. OBS att det finns lite länkar i bilder och i kommentarerna.
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 19 36Struijs
The document discusses several topics related to minimally invasive knee replacement surgery including:
1. Functional outcomes tend to be similar to traditional knee replacements but with less flexion and quadriceps avoidance.
2. Computer navigation can improve alignment accuracy but does not provide clear functional benefits.
3. Controversy exists around whether smaller incisions actually provide benefits or increased risks compared to standard incisions. Pain management is important for recovery.
Briard Jl. How To Correct Extra Articular Deformity. Slide 7 14Struijs
The document discusses deformities of the knee and their correction during total knee arthroplasty. For genu varum, which is primarily a tibial deformity, correcting the tibial joint line from oblique to perpendicular with a medial release is sufficient. For genu valgum femur, the femoral joint line needs to be reoriented from oblique to horizontal through lateral release and compensating for bone missing from the lateral condyle by adjusting the femoral component rotation. Flexion gap can be maintained by releasing the medial collateral ligament and elongating it.
Briard Jl. How To Correct Extra Articular Deformity. Slide 1 6Struijs
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.
Briard Jl. How To Correct Extra Articular Deformity. Slide 27 40Struijs
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.
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. How To Correct Extra Articular Deformity. Slide 15 26Struijs
The document discusses surgical techniques for dealing with extra-articular deformities in total knee arthroplasty (TKA). It notes that lateral collateral ligament release for femoral varum is difficult and risks postoperative instability, while medial release is safer. It recommends intra-articular correction of extra-articular deformity over extra-articular procedures. For femoral varum, it suggests medial release, lateral condyle resection, femoral rotation in internal rotation, or a medial condylar osteotomy. For tibial valgum, it recommends a lateral collateral ligament release.
Briard Jl. Are All Mb Knees The Same. Slide 1 28Struijs
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.
Jennings Lm. Wear Of Knee Replacements Influence Of Kinematics And DesignStruijs
The document discusses factors that influence wear in knee replacements, including prosthesis design and kinematics. It finds that rotating platform mobile bearing knee replacements significantly reduce wear and osteolytic potential compared to fixed bearing knees, but some of these benefits can be lost if lift-off of the femoral condyle occurs, increasing medial/lateral wear in both designs. Careful surgery and soft tissue management are important to wear performance. Rotating platform mobile bearing knees showed a four-fold reduction in wear rate compared to fixed bearing knees in simulated tests.
Johnson Dp. Mis Knee Replacement. What Are The Functional Benefits. Slide 1 18Struijs
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 39Struijs
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]
This document discusses the evolution and design of total knee arthroplasty (TKA). It describes how early TKA designs in the 1970s-1980s led to improved designs that better replicated normal knee biomechanics. The key developments included posterior cruciate ligament retaining versus substituting designs, improved patellofemoral tracking, and converting flexion-extension gaps. The document outlines the surgical technique for TKA, including approaches, bone cuts, ligament balancing, and the goals of restoring alignment and stability while maximizing range of motion.
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 53Struijs
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.
Hässleholm and Vaggeryd. Två svenska exempelLo Claesson
About cooperation with social services in Hässlholm, makerspace in Vaggeryd and both libraries' adaption to the Danish Four Room Model. This presentation was made for library staff on Greenland.
Tankar kring "Framtidens barnbibliotek" framtagna av Nätverket för barnbiblioteksverksamhet i Kalmar län 2009-2010. Sammanställt av Pia Malmberg-Kronvall, Regionbiblioteket i Kalmar län
Löken och albatrossen Trollhättan Uddevalla 11-12 juni 2018Peter Alsbjer
Jag var och föreläste om fram- och samtidens folkbibliotek i Trollhättan och Uddevalla häromdagen. Här ät presentationen jag använde mig av. OBS att det finns lite länkar i bilder och i kommentarerna.
Varför måste jag veta vad en vlog är? Linköping 21 oktober 2016Peter Alsbjer
Jag blev inbjuden av Regionbibliotek Östergötland för att prata verksamhetsutveckling, vikten av omvärldsbevakning och kompetensbehov i ett förändrat medie- och kunskapslandskap.
6. Det informella biblioteket i framtiden, man kan tänka sig att verksamheten bibliotek bryts ner i mindre enheter och antar formen av en gerillaverksamhet. (omskrivning av en beskrivning om polisens verksamhet i framtiden, ur Malmömannen, Kristian Lundberg.)