Knee anatomy,surgical approches & osteoarthritis of the knee
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presenting you Anantomy of knee joint & Approches as total knee replacement are incresing in demand now.
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Knee anatomy,surgical approches & osteoarthritis of the knee
- 1. Knee Anatomy, approaches and Review of OA By Dr. Ranveer Patel Orthopaedic Surgeon, Shreeji Orthopaedic Care
- 2. Knee
- 3. Radiology leg and Knee
- 4. Approaches of the knee joint 1.Anteromedial approaches - • Anteromedial para patellar • Subvastus anteromedial 2.Anterolateral approach 3.Posterolateral approach 4.Postero medial approach 5.Medial approaches to the knee and supporting structures 6.Transverse approaches to menisci 7.Lateral approaches to the knee and supporting structures
- 5. MEDIAL PARA PATELLAR APPROACH (VON LANGENBECK APPROACH)
- 9. Osteoarthritis • Osteoarthritis is a non- inflammatory, degenerative condition of joints Characterized by degeneration of articular cartilage and formation of new bone i.e. osteophytes.
- 10. Risk factors Obesity Abnormal mechanical loading Inherited type II collagen defects Hereditary Poor posture Injured joints and infection
- 11. Pathology • OA is a degenerative condition primarily affecting the articular cartilage (wear and tear) 1.Articular cartilage - Erosion in weight bearing area 2.Bone - Subchondral cyst, sclerosis, osteophytes. 3.Synovial membrane - Hypertrohy, decreased secretion of fluid 4.Capsule - Fibrous degeneration 5.Ligament - Contracted or elongated 6.Muscle - Wasting
- 12. Clinical features of OA • Pain • Stiffness • Restricted movement • Deformity • Muscle weakness or wasting • Joint enlargement and instability • Crepitus • Joint Effusion
- 13. Imaging
- 14. Treatment chart • Medical • Surgical • Regenerative
- 15. Surgical • Knee preserving procedures 1. Intra articular injection 2. Arthroscopic lavage and debridement 3. Corrective osteotomy 4. Mosaicplasty • Knee replacing surgeries 1. TKR 2. UKR
- 16. Injections • Visco supplementations. • Hydrocortisone.
- 17. Arthroscopic lavage • Joint debridement • Removal of loose bodies, • Joint lavage • Drilling of sclerotic lesions
- 18. Corrective osteotomy • High Tibial Osteotomy osteotomy is an option in active patients with unicompartmental OA • The fundamental goals is to unload diseased articular surfaces and to correct angular deformity at the tibiofemoral articulation.
- 19. Indications for HTO • OA With Varus Limb Alignment • OA With Valgus Limb Alignment • Osteochondritis Dessicans • Osteonecrosis • Posterolateral Instability • Chondral Resurfacing
- 20. HTO types 1. Open wedge 2. Closed wedge 3. Dome 4. Dynamic external fixator
- 23. Dome osteotomy
- 25. Mosaicplasy
- 26. Chondroplasty
- 27. THANK YOU
Editor's Notes
- Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review and Meta-analysis ONLINE FIRST Anne W.S. Rutjes, PhD; Peter Jüni, MD; Bruno R. da Costa, MSc; Sven Trelle, MD; Eveline Nüesch, PhD; and Stephan Reichenbach, MD, MSc [+-] Article and Author Information Ann Intern Med. 12 June 2012
- Subchondral Drilling, Abrasion, or Microfracture Articular chondrocytes reside in an avascular environment and do not usually effect healing when damage to the joint surface is limited to the layer of cartilage(27,47,129). Many investigators have attempted to stimulate cartilage-healing by drilling, abrading, or producing so-called microfractures in the subchondral bone(2,3,19,70,102,116,130,138,191,236). All of these techniques have in common the goal of recruiting pluripotential stem cells from the marrow by penetration of the subchondral bone.
- Survivorship of high tibial osteotomy in the treatment of osteoarthritis of the knee Finnish registry-based study of 3195 knees T. T. Niinimäki, MD, Orthopaedic Surgeon1 ; A. Eskelinen, MD, PhD, Orthopaedic Surgeon2; B. S. Mann, FRCS(Tr & Orth), Orthopaedic Surgeon3; M. Junnila, MD, Orthopaedic Surgeon4; P. Ohtonen, MSc, Statistician1; and J. Leppilahti, MD, PhD, Orthopaedic Surgeon1 + Author Affiliations 1Oulu University Hospital, PL 21, 90029 OYS, Oulu, Finland. 2Coxa Hospital for Joint Replacement, PL 652, 33101 Tampere, Finland. 3Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK. 4Turku University Hospital, PL52, 20521 Turku, Finland. Correspondence should be sent to Mr T. T. Niinimäki; e-mail: tuukka.niinimaki@fimnet.fi Abstract Previous studies from single centres or single-surgeon series report good early and mid-term results for high tibial osteotomy (HTO) in the treatment of osteoarthritis of the knee. However, the survivorship of HTO at a national level is unknown. This registry-based study included 3195 high HTOs performed between 1987 and 2008. Kaplan-Meier analysis revealed an overall survivorship of 89% (95% confidence interval (CI) 88 to 90) at five years and 73% (95% CI 72 to 75) at ten years, when conversion to total knee replacement was taken as the endpoint. Females and patients aged > 50 years had worse survivorship than males or patients aged ≤ 50 years (hazard ratio (HR) 1.26 (95% CI 1.11 to 1.43) and HR 1.41 (95% CI 1.23 to 1.64), respectively). The survivorship of HTOs performed between 1998 to 2008 was worse than for those performed between 1987 and 1997.