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.
Hip resurfacing has emerged as a viable alternative to replacement for arthritis in young patients. Selected individuals will benefit by Hip resurfacing arthroplasty offered by the Madras Joint replacement center in India. See if you qualify for this procedure.
Hip resurfacing has emerged as a viable alternative to replacement for arthritis in young patients. Selected individuals will benefit by Hip resurfacing arthroplasty offered by the Madras Joint replacement center in India. See if you qualify for this procedure.
A review of the reverse total shoulder replacement surgery and it's clinical implications for both physical rehabilitation and functional anatomy.
Objectives:
Understand basic anatomy of the shoulder complex and its implications for shoulder replacement
Understand indications for shoulder replacement
Understand differences between standard and reverse total shoulder replacements
Understand precautions following rTSA
Understand important concepts in rehabilitation following rTSA
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Total shoulder arthroplasty and reverse TSA - Hussain AlgawahmedHussainAlgawahmedMBB
Discussion of the clinical presentation of shoulder arthritis followed by treatment options and the mechanical basis of total and reverse total shoulder arthroplasty
i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.
A review of the reverse total shoulder replacement surgery and it's clinical implications for both physical rehabilitation and functional anatomy.
Objectives:
Understand basic anatomy of the shoulder complex and its implications for shoulder replacement
Understand indications for shoulder replacement
Understand differences between standard and reverse total shoulder replacements
Understand precautions following rTSA
Understand important concepts in rehabilitation following rTSA
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Total shoulder arthroplasty and reverse TSA - Hussain AlgawahmedHussainAlgawahmedMBB
Discussion of the clinical presentation of shoulder arthritis followed by treatment options and the mechanical basis of total and reverse total shoulder arthroplasty
i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.
A short presentation on total knee replacement surgical procedure. This short presentation gives brief idea of the procedure, preparation for the surgery and post surgery management.
Total knee replacement in India
Total knee replacement in hyderabad
Knee surgery in hyderabad
knee replacement in hyderabad
Knee specialist in hyderabad,
ALL (antero-lateral ligament) - extra articular ACL reconstruction - basicsMilind Tanwar
history, need, how to reconstruct, when to reconstruct.
References: *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
Biomechanical Results of Lateral Extra-articular
Tenodesis Procedures of the Knee:
A Systematic Review. Erik L. Slette, B.A., Jacob D. Mikula, B.S., Jason M. Schon, B.S., Daniel C. Marchetti, B.A.,
Matthew M. Kheir, B.S., Travis Lee Turnbull, Ph.D., and Robert F. LaPrade, M.D., Ph.D.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. ∗ Insall and others, its introduction in 1973 marked the
beginning of the modern era of total knee
arthroplasty The Total Condylar prostesis
∗ The duopatellar prosthesis evolved into the kinematic
prosthesis, which was widely used in the 1980s
Implant Evolution
4. ∗ To correct these problems, the Insall-Burstein posterior
cruciate–substituting or posterior-stabilized design was
developed in 1978 by adding a central cam mechanism to
the articular surface geometry of the total condylar
prosthesis
∗ The cam on the femoral component engaged a central
post on the tibial articular surface at approximately 70
degrees of fl exion and caused the contact point of the
femoral-tibial articulation to be posteriorly displaced,
effecting femoral rollback and allowing further flexion
5. ∗ 1980s and 1990s, patellofemoral complications became the
primary cause for reoperation in TKA. Consequently,
improved reconstruction of the patellofemoral joint has
received attention in more recent designs
∗ Some total knee systems have incorporated a deep-dish
design as one of their available modular tibial polyethylene
options. This design is similar to the original total condylar
design that uses sagittal plane concavity or dishing alone
to control anteroposterior stability
6. ∗ The CCK design has been used extensively for revision
arthroplasty when instability is present and for difficult
primary arthroplasties in patients with extreme valgus
deformity and medial collateral ligament insuffi ciency.
∗ Enlarging the central post of the tibial polyethylene insert,
constraining it against the medial and lateral walls of a
deepened central box of the femoral component . Varus-
valgus stability is controlled by this mechanism
7. ∗ Many current prosthesis designs attempt to reproduce normal
knee kinematics closely
∗ Knee motion during gait occurs in flexion and extension,
abduction and adduction, and rotation around the long axis of
the limb
∗ Average of 2 mm of posterior translation of the medial femoral
condyle on the tibia during flexion compared with 21 mm of
translation of the lateral femoral condyle medially based
pivoting of the knee explains the observed external rotation of
the tibia on the femur during extension, known as the “screw-
home mechanism’ and internal rotation of the tibia during knee
fl exion
Biomechanic of Knee Artroplasty
Kinematics…..
8. ∗ Transverse axis of fl exion and extension of knee
constantly changes and describes J-shaped curve
around femoral condyles.
9. ∗ Triaxial motion of normal knee during walking, as
measured by electrogoniometer. Flexion and
extension are about 70 degrees during swing phase
and 20 degrees during stance phase. About 10
degrees of abduction and adduction and 10 to 15
degrees of internal and external rotation occur during
each gait cycle. FF, fl atfoot; HO, heel-off; HS,
heelstrike; TO, toe-off.
10. ∗ relative merits of each design have been debated,
PCL-retaining and PCL-substituting prostheses
∗ PCL retention achieves an increased potential range
of motion by effective femoral rollback and a
relatively fl at tibial articular surface.
∗ PCL substitution achieves femoral rollback by a tibial
post and femoral cam mechanism
Role of the Posterior Cruciate Ligament in Total
Knee Arthroplasty
11. ∗ In PCL-substituting designs, posterior displacement in
fl exion is produced by the tibial post contacting the
femoral cam, with the resultant stress borne by the
prosthetic construct and ultimately transferred to the
bone-cement interface PCL-substituting designs
would have higher failure rates than PCL-retaining
devices because of loosening??? The loosening
rates of these two designs are similar at 10-year
follow-up
PCL-retaining VS PCL-substituting
prostheses
12. ∗ The relationship of the patella to the joint line is potentially
altered more with PCL-substituting prostheses than with
PCL-retaining designs. Figgie et al. suggested that joint line
elevation may alter patellofemoral mechanics and result in
postoperative pain and subluxation
∗ PCL-substituting femoral components have a cutout for a
cam mechanism. The patella and hypertrophic synovium
on the undersurface of the quadriceps tendon can bind in
this mechanism. This clinical entity, termed patellar clunk
syndrome
PCL-retaining VS PCL-substituting
prostheses
13. ∗ Another argument in favor of PCL substitution is that
significant deformity can be more reliably corrected
with its use.
∗ Scott and Volatile stated that extensive collateral
ligament release on the concave side of a fixed knee
deformity may not be effective without release of the
contracted PCL
14. ∗ This less conforming geometry in the sagittal plane is
responsible for higher tibial polyethylene contact
stresses in PCL-retaining prostheses
Retaining
20. To achieve the goals, TKR should:
1. Restore knee alignment and stability.
2. Restore patellofemoral tracking.
3. Be done with good fixation technique.
21. Alignment
∗ Vertical axis
∗ Perpendicular to transverse knee axis
∗ Mechanical axis
∗ Line from center of hip to center of
ankle
∗ Anatomical axis
∗ Line from tip of greater trochanter to
center of ankle (5-7 degrees from
mechanical axis)
22. Alignment
∗ Articular surface of tibia
∗ 3 degrees of varus
∗ Articular surface of femur
∗ 9 degrees of valgus
∗ Femoro-tibial axis
∗ 6 degrees of valgus
23. Prosthetic alignment
∗ Tibial component
∗ Placed at 90 degrees to longitudinal axis of tibial shaft
∗ Femoral component
∗ Placed in 6 degrees of valgus
25. Surgical plan
∗ Assessment of intraoperative difficulty
∗ Range of motion
∗ Sufficient flexion involve adequate exposure
∗ Inability to flex knee prevent removal of residual posterior bone
∗ Deformity
∗ MCL deficient indicate for constrained condylar prosthesis
∗ Ligamentous balance
26. Pre-operative x-ray analysis
Standing AP, lateral, skyline view of patella
Show distal femur and proximal tibia
Anatomical axis in neutral rotation
Long leg film
Determine bowing of tibia
For IM tibia alignment guide
Full length film
Determine mechanical axis
Template for component size
27. Tibia and Femur film
Degree of bone loss at femur and tibia
Typical greater on concave side of deformity
Appearance of attenuated ligament at convex side of
deformity
Subluxation
Typical lateral subluxation of tibia
Osteophyte
Diaphysis
Hardware
Extra articular bony
Deformity
Unusual canal size
Lateral film
Loose body, osteophyte
32. Surgical exposure
∗ Standard approach (anterior midline skin incision with medial
parapatellar arthrotomy)
∗ Gold standard
∗ Dissect directly to extensor mechanism
∗ Medial retinaculum incision can curve or straight
∗ Weakening quad & possible quad lag
33.
34. Surgical
exposure
Subvastus approach
Save the entire quadriceps
insertion on the patella
Minimal disruption of
quad’s mechanism
Preservation of patellar
blood supply
Improve PF stability
May injury to femoral a. in
adductor hiatus
35. Preservation of Quad’s mechanism
Advantage
Lead to decrease post-op. pain
Earlier to return of quadriceps function and strength
Improve patellar tracking and stability
Decrease lateral release
Disadvantage
Limited operative exposure
May damage to neurovascular structures
36. Surgical
exposure
Midvastus approach
Vastus medialis muscle fiber
divided in midsubstance
along the line and direction
of muscle fibers (muscle
splitting approach)
Begin at superior medial
border of patella
Quad sparing, preserve
supreme geniculate a.
37. Surgical exposure
∗ Lateral approach
∗ SevereValgus knee
∗ Plan lateral arthrotomy
∗ Increase visualization of ligamentous balancing
38. Theories of surgical technique
∗ The gap technique
∗ Develop in conjuction with the design of cruciate-substituting
prostheses
∗ The measured resection technique
∗ Develop by surgeon and designer who favored cruciate retention,
measure femoral and tibial resection
39. Bone work
Soft tissue release (in extension) to achieve alignment
Perpendicular tibial resection
Entry hole femoral IM guide
Distal femoral resection
Size the femur
Set rotational alignment of femur to achieve rectangular flexion gap
External rotation of femoral component in flexion
Lateralize of femoral component
Chamfer cut and housing cut (PS)
Posterior clearance
Balance flexion and extension gap
41. Tibia cut
∗ Tibia alignment in TKA
∗ Classic alignment
∗ Distal femur 5-6 degrees valgus
∗ Proximal tibia perpendicular to anatomical
axis
∗ Anatomic alignment (joint line technique)
∗ Distal femur 9-10 degrees valgus
∗ Proximal tibia 2-3 degrees varus
42. Step of bone cut
∗ Distal femur first
∗ Does not effect alignment of tibia cut
∗ May effect level of tibia resection
∗ Tibia first (tibial shaft axis technique)
∗ May effect both femoral rotation and resection level if use “Gap
technique”
∗ No effect if use “Measure resection”
44. Extramedullary guide
∗ Align the guide with center of tibial plateau, medial 1/3 of tubercle,
crest and center of ankle
∗ Usually need to shift the guide medially about 5-10 mm at the ankle
∗ Difficult to obese patient
45. Intramedullary guide
∗ Entry point is critical to alignment
∗ Must have pre-op template
∗ Limitation in bowed tibia
46.
47. Tibial component alignment
∗ Coronal plane
∗ Perpendicular to anatomical axis and mechanical axis
∗ Varus cut > 3 degrees has resulted in early failure
48. Tibial component alignment
∗ Sagittal plane
∗ PS TKA
∗ 3-7 degrees posterior tilt depending on each design
∗ CR TKA
∗ Follow each patient’s own posterior tilt for optimal PCL tension
49. Tibial component alignment
∗ Rotational alignment
∗ Center at medial 1/3 of tibial tubercle
∗ Slight posterolateral overhang usually occurred
when using symmetrical tibial tray
∗ Self align
∗ Insert trial implant without broaching then put
knee through range of motion and tray will
rotate to rest at certain position
∗ Recheck and landmark
50. Level of bone cut
∗ Two method for resection level
∗ 10 mm resection from less damaged compartment
∗ Lower limit of recommended PE thickness
∗ 2 mm resection below most eroded articular surface
∗ Bone preserving
∗ Gap may be to tight if only mild or moderately eroded
51. Effect of tibial cut on F-E gap
∗ Tibia cut effect both flexion and extension gap
∗ Increase posterior slope can loosen flexion gap but only slightly
52. Effect of tibial cut on F-E gap
∗ Resection too high
∗ Tight both flexion and extension
∗ Sclerotic bone not ideal for cement interdigitation
∗ Solution
∗ Recut tibia
53. Effect of tibial cut on F-E gap
∗ Resection too low
∗ Loose both flexion and extension
∗ Weaker bony support for implant
∗ Risk of peroneal nerve injury
∗ Solution
∗ Use thicker PE insert
54. FEMORAL PREPARATION
1. Remove all osteophyt . 2. Determine the entry point
of femoral rod.
The entry point of femoral rod:
. 7-10 mm anterior to the origin of the PCL.
. 3-5 mm medial to intercondylar notch.
Error in determining the point will alter the degree of valgus cutting.
55. Femoral Rod Entry Point.
. It is usually 3-5 mm medial to intercondylar notch.
Varus knee Valgus knee Varus deformity
(more medial) (far lateral)
59. Posterior condylar axis
∗ Advantage
∗ Simple instrumentation
∗ Usually accurate
∗ Neutral/Varus knees
∗ Minimal deformity
∗ No bone erosion
∗ Disadvantage
∗ Less reliable in valgus knee
∗ Severe deformity
∗ Femoral condyle hypoplasia
∗ Revision case
60. AP axis
∗ Advantage
∗ Easy to locate
∗ Primary TKA
∗ Enhance PF tracking
∗ Useful if condylar hypoplasia or mark
osteophyte
∗ Disadvantage
∗ Less reliable
∗ Trochlear dysplasia
∗ Advance PF arthritis
∗ High variability
∗ Error in presentation of
osteophtye at intercondyar
notch
61. Epicondylar axis
∗ Advantage
∗ Numerous study show it most
accurate axis
∗ Available in revision TKA
∗ Accurate in knees with condylar
hypoplasia/erosion
∗ Decrease femoral condylar lift-off
∗ Disadvantage
∗ Difficult to palpate medial epicondyle
∗ Can not seen in small incision
62. Flexion gap method
∗ Advantage
∗ Better flexion stability
∗ More reproducible
∗ Disadvantage
∗ Unreliable if
∗ Ligamentous
imbalance/insufficiency
∗ Inaccurate tibial resection
67. Patellar resurface
Surgical technique
Prepare the patella
Measure thickness
Patellar osteotomy
Inset or onset
Patellar position
PF tracking
+- Lateral release
68. Patellar resurface
Prepare patella
Remove osteophyte and synovial tissue
Measure thickness
Not less than 12 mm after resection
Patellar osteotomy surgical method
Inset (inlay) technique
Onset (onlay) technique
69. Patellar resurface
Patellar position
Medial to midline
Decrease Q angle
Better tracking
Lateral wear decrease
Lateral contact stress decrease
Tracking evaluation
No thumb technique
Tower clip
Lateral release
Good exposure
Avoid cut superior lateral geniculate artery
70. Cementing technique
∗ Cementing of both baseplate and stem are still recommended
∗ Both manual packing and cement gun work well
∗ Pulsatile larvage can reduced incidence of radiolucent line
∗ 3 mm cement mantle is ideal
71. Correct deformity
∗ Correct balancing and handling of the soft tissues
∗ Ligaments
∗ Tendons
∗ Joint capsule