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 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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