TOTAL KNEE REPLACEMENT (TKR) correction of varus and tibial bone defect
•Download as PPTX, PDF•
8 likes•1,054 views
Management during surgery for medial tibial bone defect during TOTAL KNEE REPLACEMENT (TKR)
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to TOTAL KNEE REPLACEMENT (TKR) correction of varus and tibial bone defect
Similar to TOTAL KNEE REPLACEMENT (TKR) correction of varus and tibial bone defect (20)
Recently uploaded
Recently uploaded (20)
TOTAL KNEE REPLACEMENT (TKR) correction of varus and tibial bone defect
- 1. Ammini 65 yr old B/l OA Knee more on left severe varus deformity of left
- 4. Bone loss in upper tibia
- 6. Bone graft from femur Multiple burr drill holes
- 7. Bone graft from femur fixed with a screw
- 8. Implant placed over the bone graft Bone graft from femur fixed with a screw
- 9. Final picture after cementing Bone graft from femur fixed with a screw
- 12. MANAGEMENT OF BONE DEFICIENCY IN TKR DR.SIYAD AHAMMAD JUNIOR RESIDENT IN DEPT. OF ORTHOPEDICS GOVT. TD MEDICAL COLLEGE ALAPUZHA
- 13. CAUSES arthritic angular deformity, condylar hypoplasia osteonecrosis, Trauma Previous surgery such as HTO and previous total knee replacement
- 14. Contained or cavitary defects have an intact rim of cortical bone surrounding the deficient area
- 15. Noncontained or segmental defects are more peripheral and lack a bony cortical rim
- 16. Rand classification Type I: focal metaphyseal defect, intact cortical rim Type II: extensive metaphyseal defect, intact cortical rim Type III: combined metaphyseal and cortical defect
- 17. Management Small defects (<5 mm) typically are filled with cement.
- 18. Contained type
- 19. structural bone grafts (bone block from distal femoral resection) screws within cement metal wedges in prosthesis Non Contained type
- 20. Some studies.. No progression of tibial radiolucencies was seen over 7 years in 25 knees in which screw augmented cement (polymethyl methacrylate) wasused to fill large tibial defects
- 21. 145 TKAs (20 all-polyethylene tibial components and 125 metal-backed trays) with medial tibial defects treated with screws andcement, medial collapse occurred in two lateral collapse in one all in metal-backed tibial components; no revisions were required.
- 23. Convert the concave, irregular defect to a flat one by minimal bone removal with a saw
- 24. Attach bone removed from the distal femur or proximal tibia to the flattened defect, and secure it with threaded Steinmann pins or screws
- 25. Carefully recut the upper tibial surface to create a flat upper tibial surface.
- 28. During cementing, premix a small batch of cement and use it to seal the junction of the bone graft with the tibia to prevent extrusion of cement into this interface during final component cement fixation.
- 29. If the defect cannot be corrected level the irregular bone surfaces with a burr to allow maximal graft-host bone apposition
- 30. Restoration of neutral alignment is essential because this has been shown to affect bone graft survival and prosthesis loosening. Intramedullary stems on the femoral and tibial components commonly are used to protect peripheral bone grafts from stress
- 31. Brand et al. first use of modular metal wedges attached to the tibial tray to compensate for tibial bone deficiencies
- 32. Most modern total knee systems employ modular wedges and blocks that can be attached to femoral and tibial components to compensate for multiple bone deficiencies. a surgeon can literally build a custom prosthesis in the operating room for a given defect or combination of defects.