This document provides an overview of how to perform an uncomplicated total knee replacement (TKR). It discusses patient selection and implant selection. It describes the steps of templating, making bone cuts to the femur and tibia, trialing implants, and ensuring proper soft tissue balancing and equal flexion and extension gaps. Trial implants are used to check fit and knee stability before cementing the final implants. The goals are to restore normal knee alignment and biomechanics while maximizing postoperative function and pain relief for the patient.
Journal club on Alignment and Balance Methods in - Copy.pptxpushpendrarathour1
The document discusses ligament balancing and alignment in total knee arthroplasty. It defines a balanced knee and describes the goals of ligament balancing as producing symmetrical medial-lateral gaps in extension and flexion. The key principles of ligament balancing are to have 1-3mm of laxity medially in extension and equal medial gaps in flexion/extension, with up to 3 degrees of lateral laxity in extension. Femoral rotation should be aligned to the epicondylar axis rather than adjusted in flexion to balance gaps. Alignment can be achieved via measured resection or gap balancing techniques.
The document discusses ankle instability and arthrodesis. It provides details on:
1) The classification of ankle sprains as type I, II, or III based on the ligament damage. The anatomy of the ligaments stabilizing the medial and lateral sides of the ankle are described.
2) Diagnosis of ankle injuries involves physical exams like the anterior drawer test and talar tilt test as well as radiographic views. MRI may be used if pain persists.
3) Treatment includes RICE, bracing, surgery for severe or chronic cases using various reconstruction techniques depending on the ligaments injured.
4) Ankle arthrodesis is described as an option for end-stage ankle arthritis
Total hip replacement (THR) is a common procedure to treat arthritis of the hip. Prof. John Charnley pioneered THR in the 1960s using low-friction arthroplasty with polyethylene and acrylic bone cement. THR aims to reduce joint reaction forces by recentering the femoral head and lengthening muscle lever arms. Surgeons select implants and fixation methods based on patient factors and bone quality. Outcomes depend on restoring normal hip biomechanics and long-term implant fixation to bone.
Ankle & Foot Xray & Surgical ApproachesMirant Dave
This document describes various x-ray views and surgical approaches for the foot and ankle. It provides details on the Ottawa ankle rules for determining when radiography is needed for ankle injuries. It then describes common ankle and foot x-ray views including AP, lateral, mortise, and oblique views. Finally, it outlines several surgical approaches for the ankle including anterolateral, anterior, lateral, posterolateral, and Ollier approaches.
This document describes the posterior approach for hip surgery. It is the most common approach as it allows easy access to the hip joint through a curved incision over the posterior aspect of the greater trochanter. It avoids weakness of the abductors compared to anterior approaches. Landmarks include palpating the greater trochanter. The gluteus maximus fibers are split to expose the short external rotator muscles and hip capsule. The sciatic nerve lies deep and must be protected. The posterior capsule is incised to dislocate the hip for visualization. Potential dangers include injury to the sciatic nerve or inferior gluteal vessels.
1) The document describes the technique for performing a total knee replacement, focusing on ensuring proper bone preparation and component alignment through referencing anatomical landmarks.
2) Key steps include making distal femoral and tibial cuts based on the intercondylar notch and tibial spines, respectively, to maintain the joint line.
3) Accurate rotational alignment of the femoral component is important to avoid increased shear stresses that can lead to loosening.
Journal club on Alignment and Balance Methods in - Copy.pptxpushpendrarathour1
The document discusses ligament balancing and alignment in total knee arthroplasty. It defines a balanced knee and describes the goals of ligament balancing as producing symmetrical medial-lateral gaps in extension and flexion. The key principles of ligament balancing are to have 1-3mm of laxity medially in extension and equal medial gaps in flexion/extension, with up to 3 degrees of lateral laxity in extension. Femoral rotation should be aligned to the epicondylar axis rather than adjusted in flexion to balance gaps. Alignment can be achieved via measured resection or gap balancing techniques.
The document discusses ankle instability and arthrodesis. It provides details on:
1) The classification of ankle sprains as type I, II, or III based on the ligament damage. The anatomy of the ligaments stabilizing the medial and lateral sides of the ankle are described.
2) Diagnosis of ankle injuries involves physical exams like the anterior drawer test and talar tilt test as well as radiographic views. MRI may be used if pain persists.
3) Treatment includes RICE, bracing, surgery for severe or chronic cases using various reconstruction techniques depending on the ligaments injured.
4) Ankle arthrodesis is described as an option for end-stage ankle arthritis
Total hip replacement (THR) is a common procedure to treat arthritis of the hip. Prof. John Charnley pioneered THR in the 1960s using low-friction arthroplasty with polyethylene and acrylic bone cement. THR aims to reduce joint reaction forces by recentering the femoral head and lengthening muscle lever arms. Surgeons select implants and fixation methods based on patient factors and bone quality. Outcomes depend on restoring normal hip biomechanics and long-term implant fixation to bone.
Ankle & Foot Xray & Surgical ApproachesMirant Dave
This document describes various x-ray views and surgical approaches for the foot and ankle. It provides details on the Ottawa ankle rules for determining when radiography is needed for ankle injuries. It then describes common ankle and foot x-ray views including AP, lateral, mortise, and oblique views. Finally, it outlines several surgical approaches for the ankle including anterolateral, anterior, lateral, posterolateral, and Ollier approaches.
This document describes the posterior approach for hip surgery. It is the most common approach as it allows easy access to the hip joint through a curved incision over the posterior aspect of the greater trochanter. It avoids weakness of the abductors compared to anterior approaches. Landmarks include palpating the greater trochanter. The gluteus maximus fibers are split to expose the short external rotator muscles and hip capsule. The sciatic nerve lies deep and must be protected. The posterior capsule is incised to dislocate the hip for visualization. Potential dangers include injury to the sciatic nerve or inferior gluteal vessels.
1) The document describes the technique for performing a total knee replacement, focusing on ensuring proper bone preparation and component alignment through referencing anatomical landmarks.
2) Key steps include making distal femoral and tibial cuts based on the intercondylar notch and tibial spines, respectively, to maintain the joint line.
3) Accurate rotational alignment of the femoral component is important to avoid increased shear stresses that can lead to loosening.
This document discusses the surgical approach for intercondylar/supracondylar humerus fractures using a chevron osteotomy. It describes the posterior surgical approach as being safer and providing better visualization of the articular surface compared to anterior approaches. The key steps of the posterior approach are outlined, including a midline skin incision, raising subcutaneous flaps, isolating the ulnar nerve, preparing the osteotomy site with saw and chisel, performing the chevron-shaped osteotomy, reducing and fixing the joint fragments, and coupling the fragments to the metaphysis. Complications of the procedure are also listed.
This document provides an overview of total elbow arthroplasty. It discusses the history and evolution of elbow prostheses. Modern total elbow arthroplasty involves replacing the distal humerus and proximal ulna with prosthetic components. Indications include rheumatoid arthritis, osteoarthritis, fractures, and previous failed elbow procedures. Implant designs can be fully constrained, semi-constrained, or unconstrained depending on bone and soft tissue integrity. Complications include loosening, infection, instability, and nerve issues. The goal of total elbow arthroplasty is to relieve pain and restore elbow function and range of motion.
The knee joint is composed of two articulations, the tibiofemoral joint and patellofemoral joint. The tibiofemoral joint allows 3 degrees of freedom of motion and contains the femoral condyles which articulate with the menisci and tibial plateaus. The menisci improve joint congruence and distribute weight forces. Ligaments such as the ACL, PCL, MCL and LCL provide stability to the joint. The patellofemoral joint contains the patella which articulates with the femur and is stabilized by surrounding structures like the quadriceps tendon.
This document discusses congenital club foot, also known as talipes equinovarus. It begins by defining the condition and describing the anatomical deformities present, including cavus, adductus, varus, and equinus. It then covers the epidemiology, etiology, pathoanatomy, diagnosis using physical exam and radiography scores. The Ponseti method of non-surgical manipulation and serial casting is described in detail. Surgical options are outlined for resistant or recurrent cases. Complications of both treatment approaches are also summarized.
Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
This document provides an overview of ankle arthrodesis, including:
- Indications for the procedure include pain, deformity, and instability from conditions like trauma, infection, arthritis.
- Surgical options include open arthrodesis with internal or external fixation, arthroscopic arthrodesis, and mini-open techniques.
- The goals of fusion are to relieve pain, create a stable foot, and position the ankle in 5 degrees of valgus and 5-10 degrees of external rotation.
- Potential complications include non-union, infection, nerve injury, and malunion. Outcomes studies found relief of pain but activity limitations remain.
Proximal femoral osteotomies are surgical procedures used to correct biomechanical alignment of the lower extremity through removal of a portion of bone near the femur. The objectives include improving coverage of the femoral head, containing the head, moving normal cartilage into the weight bearing zone, improving motion, relieving pain, and correcting leg length inequality. Various types of proximal femoral osteotomies are classified based on anatomical location, degree of bone displacement, and surgical indications. Common indications include osteoarthritis, femoral neck fractures, slipped capital femoral epiphysis, Legg Calve Perthes disease, and congenital hip dislocations.
MRI shoulder and knee- Anatomy, Scan Planning & Its Techniques Nitish Virmani
The document provides information about MRI procedures for the shoulder and knee joints. It describes the anatomy and indications for MRI of each joint. Suggested imaging protocols including sequences, slice thickness, and field of view are outlined for the shoulder and knee. Patient positioning and equipment used are also discussed. Common findings addressed in reports on the shoulder include rotator cuff tears and labral injuries, while meniscal tears and ligament injuries are highlighted for the knee.
This document provides an overview of distal femur fractures, including:
- The basic anatomy of the distal femur and forces around the knee joint.
- The types of distal femur fractures, which can be supracondylar, intercondylar, or complete articular breaks.
- Treatment options including non-operative management with casting, external fixation, and surgical fixation techniques like plating or intramedullary nailing.
- Potential complications from distal femur fractures include malunion, hardware issues, nonunion, and infection.
This document provides an overview of distal femur fractures, including:
- Basic anatomy of the distal femur and forces around the knee joint.
- Types of distal femur fractures include supracondylar, intercondylar, and partial or complete articular fractures.
- Clinical features include a history of trauma, pain, swelling, and deformity. Investigations include x-rays and CT scans.
- Treatment options are non-operative with casting or skeletal traction, or operative with external or internal fixation techniques like plating or intramedullary nailing.
- Surgical techniques depend on the fracture type and include various approaches like anterolateral or lateral para patellar.
-
This document describes several surgical approaches to the hip and acetabulum. It discusses the Smith-Petersen anterior approach, which provides access to the anterior hip joint. It also covers the Watson-Jones anterolateral approach, most commonly used for total hip replacement. Additionally, it summarizes the Southern posterior approach, lateral approach, and medial (Ludloff's) approach. For the acetabulum, it outlines the ilioinquinal and posterior (Kocher-Langenbeck) approaches. Each approach is defined by its indications, patient positioning, incision, exposure, dangers, and relevant references.
This document provides an overview of clubfoot (congenital talipes equinovarus), including:
1. The definition, incidence, causes, and typical deformities seen in clubfoot.
2. Evaluation methods like the Pirani scoring system and radiographic assessment.
3. Treatment approaches like the Ponseti method of serial casting and bracing, as well as surgical options like the McKay procedure when non-operative treatment fails.
4. Post-operative casting protocols and complications that can arise from treatment.
This document provides information about below knee amputation, including:
- Indications for below knee amputation include gangrene, peripheral vascular disease, trauma, burns, and severe loss of function.
- The level of amputation is determined by the disease process, tissue viability, and available prosthetics. Adequate blood flow is confirmed using clinical assessments and Doppler ultrasound.
- Postoperative care includes preventing complications, deformities, edema, strengthening muscles, and rehabilitating the patient for mobility and prosthetic use.
This document discusses nonunion of femoral neck fractures, which have a higher incidence in young patients compared to elderly patients. It defines nonunion and outlines the vascular anatomy and causes of nonunion. Classification systems for femoral neck fractures are described. Symptoms, investigations, and radiographic signs of nonunion are provided. Treatment options are discussed, including head-salvaging versus head-sacrificing procedures based on factors like patient age and viability of the femoral head. The Sandhu classification system for staging nonunion is presented along with recommended treatment approaches for each stage.
Osteotomy around the elbow is commonly performed to correct cubitus varus and cubitus valgus deformities. For cubitus varus, the most common cause is a malunited supracondylar fracture. Surgical options include lateral closing wedge osteotomy, oblique osteotomy with derotation, and medial opening wedge osteotomy with bone grafting. For cubitus valgus, causes include nonunion of a lateral condyle fracture. Surgical options are a closing wedge medial osteotomy or opening wedge lateral osteotomy. Complications of elbow osteotomy can include stiffness, persistent deformity, myositis ossificans, loss of fixation, and neurovascular injury.
1. The document discusses various deformities that can result from polio, including flexion-abduction deformities of the hip and paralysis of specific muscles like the gluteals.
2. Surgical procedures to correct deformities are described, such as the Ober-Yount procedure for hip flexion-abduction contractures and the Sharrard/Mustard procedures to transfer the iliopsoas muscle for gluteal paralysis.
3. Paralytic dislocation of the hip and treatment methods including reduction, muscle transfers, and osteotomies are also summarized.
This document discusses instability after total knee arthroplasty (TKA). It begins by outlining the goals and basic principles of TKA. It then describes the bone cuts made during TKA and emphasizes that resection of the proximal tibia influences both flexion and extension gaps. The document discusses various causes of instability after TKA including improper bone cuts, soft tissue imbalance, and component malpositioning. It provides details on managing different types of instability such as instability in extension, flexion, and mid-flexion. Prevention of instability through proper bone cuts and soft tissue balancing is emphasized.
1) The document discusses the planning of a high tibial osteotomy (HTO) procedure, including a brief history of osteotomies, knee axis anatomy, indications for HTO, preoperative planning considerations, and techniques for planning correction angles and wedge sizes.
2) Key factors in planning include determining the nature and location of deformity, ideal candidates for HTO vs other procedures, and calculating the needed correction angle based on methods like the Fujisawa scale.
3) Precise planning is important for procedures like open vs closed wedge osteotomy and correcting any concomitant deformities in the sagittal or transverse planes.
This document discusses various surgical approaches to the hip joint, including anterior, anterolateral, lateral, and posterior approaches. It provides details on the Smith-Peterson anterior approach, including patient positioning, incision location in the internervous plane between the sartorius and tensor fascia latae muscles, and exposure of the hip joint capsule. It also describes the Watson-Jones anterolateral approach, including positioning the greater trochanter at the edge of the table, incising the fascia lata posterior to the tensor fasciae latae, and reflecting muscles to expose the joint capsule and femoral head. Finally, it outlines the lateral approach, with incision centered over the greater trochan
Revision total ankle replacement can successfully salvage failed primary total ankle replacements. The procedure involves removing the old components, preparing new bone cuts on the tibia and talus, and cementing new tibial and talar components. In a study of 41 patients who underwent revision surgery, 34 retained the new ankle replacement, 5 required subsequent ankle fusion, and 2 required amputation. At follow up around 4 years, patients showed improved range of motion and good functional outcomes based on standardized scores. The procedure can manage common causes of primary failure like talar subsidence or loosening. Careful exposure, bone preparation and cementing technique are essential for achieving stable fixation of the revision components.
This document discusses the surgical approach for intercondylar/supracondylar humerus fractures using a chevron osteotomy. It describes the posterior surgical approach as being safer and providing better visualization of the articular surface compared to anterior approaches. The key steps of the posterior approach are outlined, including a midline skin incision, raising subcutaneous flaps, isolating the ulnar nerve, preparing the osteotomy site with saw and chisel, performing the chevron-shaped osteotomy, reducing and fixing the joint fragments, and coupling the fragments to the metaphysis. Complications of the procedure are also listed.
This document provides an overview of total elbow arthroplasty. It discusses the history and evolution of elbow prostheses. Modern total elbow arthroplasty involves replacing the distal humerus and proximal ulna with prosthetic components. Indications include rheumatoid arthritis, osteoarthritis, fractures, and previous failed elbow procedures. Implant designs can be fully constrained, semi-constrained, or unconstrained depending on bone and soft tissue integrity. Complications include loosening, infection, instability, and nerve issues. The goal of total elbow arthroplasty is to relieve pain and restore elbow function and range of motion.
The knee joint is composed of two articulations, the tibiofemoral joint and patellofemoral joint. The tibiofemoral joint allows 3 degrees of freedom of motion and contains the femoral condyles which articulate with the menisci and tibial plateaus. The menisci improve joint congruence and distribute weight forces. Ligaments such as the ACL, PCL, MCL and LCL provide stability to the joint. The patellofemoral joint contains the patella which articulates with the femur and is stabilized by surrounding structures like the quadriceps tendon.
This document discusses congenital club foot, also known as talipes equinovarus. It begins by defining the condition and describing the anatomical deformities present, including cavus, adductus, varus, and equinus. It then covers the epidemiology, etiology, pathoanatomy, diagnosis using physical exam and radiography scores. The Ponseti method of non-surgical manipulation and serial casting is described in detail. Surgical options are outlined for resistant or recurrent cases. Complications of both treatment approaches are also summarized.
Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
This document provides an overview of ankle arthrodesis, including:
- Indications for the procedure include pain, deformity, and instability from conditions like trauma, infection, arthritis.
- Surgical options include open arthrodesis with internal or external fixation, arthroscopic arthrodesis, and mini-open techniques.
- The goals of fusion are to relieve pain, create a stable foot, and position the ankle in 5 degrees of valgus and 5-10 degrees of external rotation.
- Potential complications include non-union, infection, nerve injury, and malunion. Outcomes studies found relief of pain but activity limitations remain.
Proximal femoral osteotomies are surgical procedures used to correct biomechanical alignment of the lower extremity through removal of a portion of bone near the femur. The objectives include improving coverage of the femoral head, containing the head, moving normal cartilage into the weight bearing zone, improving motion, relieving pain, and correcting leg length inequality. Various types of proximal femoral osteotomies are classified based on anatomical location, degree of bone displacement, and surgical indications. Common indications include osteoarthritis, femoral neck fractures, slipped capital femoral epiphysis, Legg Calve Perthes disease, and congenital hip dislocations.
MRI shoulder and knee- Anatomy, Scan Planning & Its Techniques Nitish Virmani
The document provides information about MRI procedures for the shoulder and knee joints. It describes the anatomy and indications for MRI of each joint. Suggested imaging protocols including sequences, slice thickness, and field of view are outlined for the shoulder and knee. Patient positioning and equipment used are also discussed. Common findings addressed in reports on the shoulder include rotator cuff tears and labral injuries, while meniscal tears and ligament injuries are highlighted for the knee.
This document provides an overview of distal femur fractures, including:
- The basic anatomy of the distal femur and forces around the knee joint.
- The types of distal femur fractures, which can be supracondylar, intercondylar, or complete articular breaks.
- Treatment options including non-operative management with casting, external fixation, and surgical fixation techniques like plating or intramedullary nailing.
- Potential complications from distal femur fractures include malunion, hardware issues, nonunion, and infection.
This document provides an overview of distal femur fractures, including:
- Basic anatomy of the distal femur and forces around the knee joint.
- Types of distal femur fractures include supracondylar, intercondylar, and partial or complete articular fractures.
- Clinical features include a history of trauma, pain, swelling, and deformity. Investigations include x-rays and CT scans.
- Treatment options are non-operative with casting or skeletal traction, or operative with external or internal fixation techniques like plating or intramedullary nailing.
- Surgical techniques depend on the fracture type and include various approaches like anterolateral or lateral para patellar.
-
This document describes several surgical approaches to the hip and acetabulum. It discusses the Smith-Petersen anterior approach, which provides access to the anterior hip joint. It also covers the Watson-Jones anterolateral approach, most commonly used for total hip replacement. Additionally, it summarizes the Southern posterior approach, lateral approach, and medial (Ludloff's) approach. For the acetabulum, it outlines the ilioinquinal and posterior (Kocher-Langenbeck) approaches. Each approach is defined by its indications, patient positioning, incision, exposure, dangers, and relevant references.
This document provides an overview of clubfoot (congenital talipes equinovarus), including:
1. The definition, incidence, causes, and typical deformities seen in clubfoot.
2. Evaluation methods like the Pirani scoring system and radiographic assessment.
3. Treatment approaches like the Ponseti method of serial casting and bracing, as well as surgical options like the McKay procedure when non-operative treatment fails.
4. Post-operative casting protocols and complications that can arise from treatment.
This document provides information about below knee amputation, including:
- Indications for below knee amputation include gangrene, peripheral vascular disease, trauma, burns, and severe loss of function.
- The level of amputation is determined by the disease process, tissue viability, and available prosthetics. Adequate blood flow is confirmed using clinical assessments and Doppler ultrasound.
- Postoperative care includes preventing complications, deformities, edema, strengthening muscles, and rehabilitating the patient for mobility and prosthetic use.
This document discusses nonunion of femoral neck fractures, which have a higher incidence in young patients compared to elderly patients. It defines nonunion and outlines the vascular anatomy and causes of nonunion. Classification systems for femoral neck fractures are described. Symptoms, investigations, and radiographic signs of nonunion are provided. Treatment options are discussed, including head-salvaging versus head-sacrificing procedures based on factors like patient age and viability of the femoral head. The Sandhu classification system for staging nonunion is presented along with recommended treatment approaches for each stage.
Osteotomy around the elbow is commonly performed to correct cubitus varus and cubitus valgus deformities. For cubitus varus, the most common cause is a malunited supracondylar fracture. Surgical options include lateral closing wedge osteotomy, oblique osteotomy with derotation, and medial opening wedge osteotomy with bone grafting. For cubitus valgus, causes include nonunion of a lateral condyle fracture. Surgical options are a closing wedge medial osteotomy or opening wedge lateral osteotomy. Complications of elbow osteotomy can include stiffness, persistent deformity, myositis ossificans, loss of fixation, and neurovascular injury.
1. The document discusses various deformities that can result from polio, including flexion-abduction deformities of the hip and paralysis of specific muscles like the gluteals.
2. Surgical procedures to correct deformities are described, such as the Ober-Yount procedure for hip flexion-abduction contractures and the Sharrard/Mustard procedures to transfer the iliopsoas muscle for gluteal paralysis.
3. Paralytic dislocation of the hip and treatment methods including reduction, muscle transfers, and osteotomies are also summarized.
This document discusses instability after total knee arthroplasty (TKA). It begins by outlining the goals and basic principles of TKA. It then describes the bone cuts made during TKA and emphasizes that resection of the proximal tibia influences both flexion and extension gaps. The document discusses various causes of instability after TKA including improper bone cuts, soft tissue imbalance, and component malpositioning. It provides details on managing different types of instability such as instability in extension, flexion, and mid-flexion. Prevention of instability through proper bone cuts and soft tissue balancing is emphasized.
1) The document discusses the planning of a high tibial osteotomy (HTO) procedure, including a brief history of osteotomies, knee axis anatomy, indications for HTO, preoperative planning considerations, and techniques for planning correction angles and wedge sizes.
2) Key factors in planning include determining the nature and location of deformity, ideal candidates for HTO vs other procedures, and calculating the needed correction angle based on methods like the Fujisawa scale.
3) Precise planning is important for procedures like open vs closed wedge osteotomy and correcting any concomitant deformities in the sagittal or transverse planes.
This document discusses various surgical approaches to the hip joint, including anterior, anterolateral, lateral, and posterior approaches. It provides details on the Smith-Peterson anterior approach, including patient positioning, incision location in the internervous plane between the sartorius and tensor fascia latae muscles, and exposure of the hip joint capsule. It also describes the Watson-Jones anterolateral approach, including positioning the greater trochanter at the edge of the table, incising the fascia lata posterior to the tensor fasciae latae, and reflecting muscles to expose the joint capsule and femoral head. Finally, it outlines the lateral approach, with incision centered over the greater trochan
Revision total ankle replacement can successfully salvage failed primary total ankle replacements. The procedure involves removing the old components, preparing new bone cuts on the tibia and talus, and cementing new tibial and talar components. In a study of 41 patients who underwent revision surgery, 34 retained the new ankle replacement, 5 required subsequent ankle fusion, and 2 required amputation. At follow up around 4 years, patients showed improved range of motion and good functional outcomes based on standardized scores. The procedure can manage common causes of primary failure like talar subsidence or loosening. Careful exposure, bone preparation and cementing technique are essential for achieving stable fixation of the revision components.
Best Digital Marketing Strategy Build Your Online Presence 2024.pptxpavankumarpayexelsol
This presentation provides a comprehensive guide to the best digital marketing strategies for 2024, focusing on enhancing your online presence. Key topics include understanding and targeting your audience, building a user-friendly and mobile-responsive website, leveraging the power of social media platforms, optimizing content for search engines, and using email marketing to foster direct engagement. By adopting these strategies, you can increase brand visibility, drive traffic, generate leads, and ultimately boost sales, ensuring your business thrives in the competitive digital landscape.
Explore the essential graphic design tools and software that can elevate your creative projects. Discover industry favorites and innovative solutions for stunning design results.
Architectural and constructions management experience since 2003 including 18 years located in UAE.
Coordinate and oversee all technical activities relating to architectural and construction projects,
including directing the design team, reviewing drafts and computer models, and approving design
changes.
Organize and typically develop, and review building plans, ensuring that a project meets all safety and
environmental standards.
Prepare feasibility studies, construction contracts, and tender documents with specifications and
tender analyses.
Consulting with clients, work on formulating equipment and labor cost estimates, ensuring a project
meets environmental, safety, structural, zoning, and aesthetic standards.
Monitoring the progress of a project to assess whether or not it is in compliance with building plans
and project deadlines.
Attention to detail, exceptional time management, and strong problem-solving and communication
skills are required for this role.
3. Patient Selection
Indication
• Progressive pain
• Deterioration of ADL
• Analgesic dependent
• Disturb sleep Depression
Contraindication
• Active Infection
• Charcot joint
• Poor skin coverage
• Lack of muscle control
• Inability to participate in
post-op rehab
4. Implant selection- Principles
• PCL sacrifice vs retaining
• Fixed vs mobile bearing
• Cemented vs uncemented vs hybrid
• Patella resurfacing vs non-resurfacing
• Unicondylar Knee
• Constraint vs Non-constraint
• Bio-materials
7. Accuracy?
Unnanuntana A, JMAT, 2007
• A retrospective study of 98 patients and 113 knees was
carried out. The operative records were then reviewed
to determine the size of the implant used during the
operation.
• Approximately 50% of the patients had a preoperative
template size that matched the actual implant used.
• Many factors influence the final choice of the
prosthesis used during total knee replacement;
therefore, the preoperative template size can only be
used as a rough guide.
9. PATELLA BIOMECHANICS: Q ANGLE
• Angle formed by line drawn from ASIS to
centre of patella and second line drawn from
centre of patella to tibial tubercle
• Normal: 14 degrees males / 17 degrees
females
• Any factor that causes an increase in the Q
angle can cause lateral maltracking of the
• patella
• Increased by:
– Genu valgum
– Patella subluxation (lateral release)
– Tight lateral retinaculum (lateral release)
10. PATELLA BIOMECHANICS: PATELLA ALTA &
PATELLA BAJA
INSALL’S INDEX
• Length of Patella
Tendon to Length of
Patella
• Normal: 1:1
• Patella Alta (Long
patella tendon) >
1.3:1
• Patella Baja (Short
patella tendon) <
1:1
11. MECHANICAL AXIS OF KNEE JOINT
• Line extending from
centre of Hip Joint to
centre of Ankle Joint
• Perpendicular to ground
• In normal knee,
mechanical axis passes
through centre of knee
• Axis of Tibio-Femoral
articulation is horizontal
and parallel to horizontal
axis of Ankle Joint
12. Mechanical axis of tibia
• Mechanical axis of tibia is
3 degrees valgus of it’s
anatomical axis.
• In view of this difference,
therefore need to
externally rotate the
femoral component about
3 degrees in relation to
the posterior condyles, to
get it perpendicular to the
mechanical axis.
13.
14. ANATOMICAL AXIS OF KNEE
• Axis extending along
shafts of femur and
tibia
• Not important
15. Preparation of soft tissue + removal of
osteophytes
• Marginal osteophytes removed to provide for proper
balancing
• Posterior osteophyte removed with curve osteotome
to prevent impingement during flexion
• In general, it is advisable to remove all osteophytes and
reevaluate for the soft tissue imbalance.
• Usually after the osteophytes are removed and normal
anatomic planes have been reestablished, no specific
releases or additional ligamentous balancing are
necessary.
16. When to do ligamentous balancing?
• Open the knee joint and make a preliminary balancing of the soft
issue structures appropriate to the situation. Remove osteophytes.
• Perform bone cuts according to the preoperative plan.
• Make a fine adjustment of soft tissues after checking the flexion
and extension gaps with the gap gauge or at the latest after
inserting the trial prosthesis.
• This prevents the release being too extensive, which would result in
laxity of the ligaments after insertion of the final implant.
• Based on their observations it is recommended undertaking a 1⁄2-
to 3⁄4- resection of the Hoffa fat pad. This is independent of
surgical approach. Fibrosis or a fat pad impingement can cause
anterior knee pain.
• In order to maintain the continuity of the joint capsule, the base of
the meniscus should be left intact when resecting the meniscus or
its remnants.
17. Bone Cuts
• There are five essential bony cuts for any TKA.
• The essential bone cuts are made regardless of
the amount of bone loss, ligamentous imbalance,
or osteophytes presence about the knee.
• Bone cuts
– Minimise bone resection
– Maintain joint line
– Horizontal joint line
– Balance flexion and extension gap
18. The five essential bone cuts
• Transverse osteotomy of the proximal tibia, tilted
5 degrees posteriorly
• Resection of the distal femoral condyles,
angulated at 50 to 70 of valgus alignment
• Anterior and posterior condylar resections to
accept a prosthesis of the appropriate size
• Chamfers from the distal femur anteriorly &
posteriorly
• Resection of the intercondylar notch & PCL
19. Tibia Cut
• Cut the tibia
perpendicular to
the mechanical axis
of the limb with a
posterior slope of 0-
5 degrees
depending on the
design of prosthesis
20. POSTERIOR SLOPE ?
•Advantage
– Opening up the flexion gap to make PCL balancing
easier & enhancing metal-to-plastic contact in
max knee flexion
• Disadvantage
– The promotion of too much rollback of the femur
on the tibia in a nonconforming design
21. Tibia Cut
•The tibial guide is
usually set to engage
the ankle 3 to 6mm
medial of centre, as
the centre of talus is
usually medial to the
line bisecting the
distance between the
malleoli
25. • Femoral Cuts
– Create normal valgus angle (5-9 degrees)
and original joint line
– Equal flexion and extension gap
– Slight external rotation (3 degree) to
improve patella tracking
• Rotational femoral alignment is
assessed by
– Posterior condylar axis
– Anterioposterior axis (Whiteside’s Line)
– Transepicondylar axis
29. • Drill hole in distal femur and
insert femoral IM alignment
guide
• The medullary canal of the
femur is entered approximately
1 cm above the origin of the PCL
& a few millimeters medial to
the true center of the
intercondylar notch
30.
31.
32.
33. Referencing and sizing
• Determine the size of the femoral component in both the A/P and
the M/L directions.
• Mount the femoral size gauge on the intramedullary alignment rod
to determine the A/P dimension of femoral component.
• Both feet of the femoral size gauge must have good contact with
the posterior condyles. The point of the stylus should rest on the
anterior femoral cortex.
• Place the point of the stylus on the deepest point of the anterior
femoral cortex above the edge of the cartilage in order to obtain
optimal measurement.
• The size of the femoral component is read on the vertical scale. In
the case of intermediate sizes, choose the smaller size.
34.
35. • Check the dimension in the M/L direction with
the femoral gauge.
• In cases of intermediate sizes, this
measurement can facilitate the choice of the
final component.
• The size determined in the A/P direction can
be checked with the other side of the femoral
gauge.
36.
37.
38. EXTENSION –FLEXION GAP
• After the bone cut, there will be a flexion and
extension gap between the distal femur and
proximal tibia.
• If the knee can be aligned passively, the
conditions for a stable and mobile knee are that
the flexion and extension gaps are normal and
equal.
• This involves the femoral and tibial cuts so that
both the flexion and the extension spaces, or
‘gaps’, are rectangular and roughly equal in size.
39. • The flexion gap is determined with the knee
in 90 degrees of flexion and the extension
gap is determined with the knee in full
extension.
• Balance of the flexion and extension gaps can
be determined by placing spacer blocks or a
tensor within the gaps with the knee in both
flexion and extension
40.
41. Equal extension and Flexion gap
•Tibial cut affects
flexion and extension
gaps equally
•Distal femoral cut
affects extension gap
only
•Posterior femoral cut
affects flexion gap only
42. • If the extension gap is too small or tight,
extension will be limited.
• If the flexion gap is too tight, flexion will be
limited.
• If extension gap is smaller than the flexion gap,
remove more bone from the distal femoral cut
surface.
• If the flexion gap is smaller than the extension
gap, more bone can be removed from the
posterior femoral condyles.
43. • If the flexion and extension gap is equal, but
there is not enough space for the desired
prosthesis, remove more bone from the
proximal tibia, because it will affect equally
the flexion and extension gaps.
• If the flexion and extension gaps are equal but
lax, a larger spacer block and ultimately a
larger tibial polyethylene insert are required
to obtain stability (Guyton 1998).
44. • In theory, the amount of bone taken from the
distal femur is equivalent to the thickness of
the distal femoral component of the
prosthesis
• The amount of bone resected from the
proximal tibia is equivalent to the thickness
of the tibial plateau that is being replaced.
45. • The femoral component is placed onto the distal
femur and securely fitted, and the tibial plateau
placed on the tibial surface. Trial component of
the tibial insert then inserted.
• With flexion and extension the tibial plateau will
tend to rotate itself into the correct alignment
with the distal femur.
• Varus and valgus stresses applied to look for the
knee stability and appropriate tibial insert can be
determined.
46. • Rotation of the tibial component of the prosthesis on
the tibial plateau must be checked carefully.
• If the tibial component is internally rotated and the
tibial tubercle is externally rotated to the midportion of
this component there will be tendency for the patella
to sublux or dislocate.
• It is imperative to externally rotate the tibial
component so that it’s midportion lies directly under
the patellar tendon.
• A general guideline is to have the center of the tibial
tray align over the medial one third of the tibial
tubercle.
47.
48. • Patella stability is then check. The knee is
taken into flexion to be sure that the patella
tracks centrally.
• If the rotation of the femoral component is
appropriate, the patella will remain seated
squarely in the intercondylar notch.
• If the retinaculum is too tight laterally, the
patella will begin to tilt or dislocate, requiring
lateral release.
As the tibia cut is usually cut at neutral angles, therefore femoral cut must have 3 degrees external rotation, in order to get a horizontal tibio-femoral joint to be perpendicular to the horizontal axis. (Because the mechanical axis is 3 degrees valgus of it’s anatomical axis)
Neutral femoral rotational alignment and a 3 degrees varus tibial cut (anatomic) results in a symmetric flexion gap. Varus cut of tibia, means the tibia piece is tilted upwards about 3 degrees at the medial portion, in relation to the lateral portion. A varus tibia cut will lead to a valgus knee.
- Neutral femoral rotational alignment and a neutral (90 deg) tibial cut results in an asymmetric flexion gap that is tight medially.
However with a 3 deg of ER of the femoral component alignment results in restoration of a symmetric flexion gap
External rotate = rotate towards latera
Valgus angle of femur ( anatomical axis in relation to mechanical axis ) is 5-9 degrees. More in female
When imagining valgus angle, go from tibia towards femoral. It is mechanical axis vs anatomical axis.
- The femoral cutting jig should be placed according to the posterior condylar axis, TEA and also the whiteside’s line.
External rotate = rotate towards lateral
Left leg
Right femur
Choosing the size of the femoral cutting jig.
Can either use the margins of the anterior cortex or margins of the posterior condyles as reference to choose size of the cutting jig.