Complete Knee Arthroplasty

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Presentation. TKA is a standout amongst the best and regularly performed orthopedic surgery.The best results for TKA at 10

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Add up to Knee Arthroplasty 06/06/2006 Dr. Rami Eid

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Introduction TKA is a standout amongst the best and regularly performed orthopedic surgery. The best outcomes for TKA at 10 – 15 yrs. contrast with or outperform the best aftereffect of THA.

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Indications for Knee Arthroplasty

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Indications for TKA Relieve torment brought on by osteoarthritis of the knee (the most well-known). Disfigurement in patients with variable levels of agony: Flexion contracture > 20 degrees. Serious varus or valgus laxity.

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Osteoarthritis American College of Rheumatology arrangement criteria: Knee torment and radiographic osteophytes and no less than 1 of the accompanying 3 things: Age >50 years. Morning solidness <=30 minutes in term. Crepitus on movement.

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Contraindications for TKA Recent or current knee sepsis. Remote wellspring of progressing disease. Extensor system intermittence or serious brokenness. Easy, well working knee arthrodesis. Weakness or systemic sicknesses (relative contraindications).

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Indications: Younger patients with unicompartmental ailment rather than HTO. Elderly thin patient with unicompartmental ailment (shorter recovery, more prominent ROM) Contraindications: Flexion contracture >= 5 degrees. ROM < 90 degrees. Precise deformation >= 15 degrees. Cartilaginous disintegration in the weight-bearing range of the inverse compartment. Unicondylar Knee Arthroplasty

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Patellar Resurfacing Indication for leaving the patella unresurfaced: Congruent patellofemoral following. Typical anatomical patellar shape. No proof of crystalline or fiery arthropathy. Lighter patient.

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Classification

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Classification 1 3 1-Cruciate holding 2-Cruciate substituting 3-Mobile bearing 4-Unicondylar 4 2

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Biomechanics of Knee Arthroplasty

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Kinematics The TRIAXIAL movement of the knee: Articular geometry Ligamentous limitations

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Degrees of Freedom

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Degrees of Freedom Constrained Prostheses Non-compelled Prostheses Intermediated Prostheses

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Constrained Prostheses Hinged inserts. One level of flexibility.

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Non-obliged Prostheses Ideal inserts. 5 degrees of flexibility. In place ligamentous framework.

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Intermediated Prostheses Anterior-back steadiness. Two sorts: FREEMAN (a chamber in a non accommodating trough). INSALL (back balanced out knee).

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Intermediated Prostheses Freeman Insall

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Longitudinal Alignment Of Knee Tibial segments are embedded opposite to the mechanical hub. Femoral part is embedded in 5 – 6 degrees of valgus.

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Longitudinal Alignment Of Knee Posterior tibial tilt is around 5 – 7 degrees. Generally rely on upon the articular plan. Anatomic tilt 5 degrees

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Rotational Alignment Of Knee Create a rectangular flexion space. Outside revolution of the femoral part 3 degrees.

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Role of PCL – Femoral Roll-Back

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Role of PCL – Femoral Roll-Back

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PCL holding prostheses: Better ROM (move back, level tibial surface). More symmetrical walk (stair climbing). Less femoral bone resection is required. PCL should be exactness adjusted. PCL substituting prostheses: Easier surgical introduction. See-saw impact anticipation. Bring down tibial polyethylene contact stretch Posterior tibial part relocation. Patella thump disorder. PCL-maintenance or PCL-substitution ?

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PCL-maintenance or PCL-substitution ?

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PCL-maintenance or PCL-substitution ?

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Patella Clunk Syndrome

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Patellofemoral Joint The patella demonstrations to protract extensor lever arm. This arm is most prominent at 20 degrees of flexion.

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Patellofemoral Joint Changes in the patellar region of contact can prompts to whimsical stacking of the patellofemoral joint.

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Patellofemoral Joint Limb with bigger Q edge has a more prominent propensity for parallel subluxation. Counteracting subluxation: Prosthetic segment. Vastus medialis (in early flexion).

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Polyethylene Issues 1-Dished polyethylene stays away from the edge stacking. (as PCL substitution) 2-Minimal polyethylene thickness >= 8 mm to maintain a strategic distance from higher contact push.

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Surgical Technique for Primary TKA

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Preoperative Evaluation Soft tissue abandons around the knee. Vascular status to the appendage. Extensor system. Preoperative scope of movement. Standing (AP) see, a horizontal perspective of the knee, and a horizon perspective of the patella.

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Surgical Preparation Administer a measurement of a 1 st era cephalosporin (or vancomycin, clindamycin) Avoid weight on fringe nerves.

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Surgical Approaches Medial parapatellar retinacular approach. Subvastus approach. Midvastus approach.

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Subvastus approach: Intact extensor component. Diminishing torment. More restricted. Postoperative hematoma. Midvastus approach: Preserve genicular a. to the patella. Contraindication in constrained preoperative flexion. Postoperative hematoma. Surgical Approaches

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Surgical Approaches Lateral parapatellar retinacular approach: In valgus knees. Enhance patellar following and ligamentous adjusting.

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Bone Preparation – IM Femoral Guide

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Bone Preparation – Gap Technique

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Bone Preparation – Tibial Resection The guide is adjusted to the foremost tibial ligament and first web space of the toes.

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Balancing of The Knee

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Varus Deformity 1 st Osteophytes must be expelled. 2 nd Release the profound MCL. 3 rd Release semimembranosus and pes anserinus addition. 4 th discharge back container and PCL.

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Varus Deformity

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Valgus Deformity 1 st Remove all osteophytes. 2 nd discharge horizontal case. 3 rd Lesser disfigurement: discharge Iliotibial band. More prominent distortion: discharge LCL +/ - PCL. Valgus disfigurement + flexion contracture >> discharge back container.

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Valgus Deformity

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Flexion Contracture Extension hole < Flexion hole >> more distal femoral bone cut, back case discharge. Flexion hole < Extension hole >> bigger tibial embed.

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Flexion – Extension Balancing

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Computer Assisted Surgery in Total Knee Arthroplasty

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Management of Bone Deficiency

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Patellofemoral Tracking Internal turn of tibial segment builds the propensity to horizontal patellar subluxation. Prosthetic patella ought to be medially situated.

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Postoperative Management

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Roentgenographic Evaluation

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Total knee substitution practice convention Postoperative day 1 Bedside works out (e.g. lower leg pumps, quadriceps works out… ) Postoperative day 2 Exercises for dynamic ROM and terminal knee expansion Gait preparing with assistive gadget Postoperative day 3-5 Progression of ambulation on level surfaces and stairs (if appropriate) Postoperative day 5 to 4 weeks Stretching of quadriceps and hamstring muscles Progression of ambulation separation

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Specific Disorders

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Previous HTO Difficult surgical presentation. Sidelong ligamentous laxity. Troublesome stem situation. Patella infera.

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Previous Patellectomy PCL holding arthroplasty for better outcomes.

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Complications of Total Knee Arthroplasty Thromboembolism. Disease. Neurovascular difficulties. Patellofemoral entanglements. Periprosthetic cracks.

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Patellofemoral Complications Patella thump disorder. Patellar segment disappointment. Break of patellar tendon.

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Periprosthetic Fractures

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THANK YOU

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MoKazem.com هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي. الموقع غير مسؤول عن الأخطاء الواردة في هذه المحاضرة. This address is one of a progression of addresses were arranged and introduced by occupants in the bureau of orthopedics in Damascus healing center, under the supervision of Dr. Bashar Mirali. This site is not mindful of any misstep may exist in this address. Dr. Muayad Kadhim د. مؤيد كاظم

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