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Planning knee replacement on xrays
- 1. PLANNING & TEMPLATE VAIBHAV BAGARIA Joint Replacement Surgeon Sir HN Reliance Foundation Hospital Girgaum, Mumbai
- 2. GOALS • Well Aligned • Well Balanced • Linear Patellar Tracking • Infection free healing
- 3. EXPECTATIONS • REDUCE PAIN • IMPROVE FUNCTION • IMPROVE QUALITY OF LIFE
- 4. PREOPERATIVE WORKUP • PATIENT SELECTION • PREOP MEDICAL ASSESMENT • CLINICAL EXAM • RADIO EXAM • IMPLANT SELECTION • COUNSELLING AND CONSENTING
- 5. TECHNICAL GOALS • RESTORATION OF THE NEUTRAL MECHANICAL ALIGNMENT • PRESERVATION ( RESTORATION) OF JOINT LINE • PERIARTICULAR LIGAMENT BALANCING • MAINTAING LINEAR PATELLAR TRACKING AND Q ANGLE
- 6. IMAGING • STANDARD AP/ LAT/ SKYLINE VIEWS • SCANNOGRAM - PREFERABLE BUT NOT MANDATORY
- 7. SCANNOGRAM • EXTREMES OF HEIGHT • ALTERED HIP/FEMORAL NECK ANATOMY: DYSPLASIA, TRAUMA, INFECTION, PREVIOUS OPERATION • OBVIOUS CLINICAL DEFORMITY OF TIBIA AND FEMORAL SHAFTS
- 8. SUPPLEMENTARY IMAGING • TUNNEL VIEW: POSTERIOR WB SURFACE, OCD, LOOSE BODIES • CT/MRI: COMPLEX PRIMARY FOLLOWING TRAUMA, DYSPLASIA, ALTERED BONE STOCK OR PATIENT SPECIFIC INSTRUMENTATION
- 9. What to see? • Determine the femoral & tibial cuts and cut angles • Position of the femoral canal entry point • Anticipating the ligament release • Identifying the bone defects, joint subluxation or lig laxity • Tempting prosthetic components
- 10. AP View • Joint Compartments affected & Deformity • Osteophytes: Imp for releases • Evidence of previous surgery • Alignment & Templating
- 11. Lateral view • Flexion deformity • Osteophytes • Alignment • Subchondral sclerosis • Vessels
- 12. On femur: FAA, FMA, VCA • Femoral Anatomical axis: Line that bisects the Intramedulary canal • Exit point determines the entry point of IM jig • Draw Valgus Cut Angle: 5 - 7 degree decreasing with patient height. • VCA is perpendicular to femoral mechanical axis ( FMA)
- 14. Tibia • Anatomic axis corresponds to Mechanical Axis • IM or EM Jigs Used • The cut is perpendicular to both • If deformity MA is to be considered
- 15. Tibial Axis
- 30. QUIZ TIME
- 37. Take Home Message • FAA • TAA • Valgus Cut • Tibial Cut • Osteophyte • Implant Sizing & Positioning Proper preoperative planning prevents piss- poor performance