Prof. P Aglietti Director of the First Orthopedic Clinic University of Florence, Italy

1656 days ago, 679 views
PowerPoint PPT Presentation
Guarantees, guarantees

Presentation Transcript

Slide 1

MIS TKA today Prof. P Aglietti Director of the First Orthopedic Clinic University of Florence, Italy

Slide 2

Promises, guarantees … Less injury Less torment Less blood misfortune Faster restoration Better cosmesis

Slide 3

Mini-Subvastus versus Traditional Medial ParaPatellar Prospective, coordinated case-control consider Implants: LPS (stemmed tibial segment) Analgesia: femoral nerve piece + PCEA Mini-Subvastus – 60 TKA Traditional Medial ParaPatellar – 60 TKA Boerger-Aglietti, CORR 2005

Slide 4

Mini-Subvastus L-molded capsular cut

Slide 5

Limited limit analyzation over the septum

Slide 6

Tibia first (in situ) Patella not everted

Slide 7

Distal cut from average

Slide 8

Exposure of both condyles

Slide 9

Complete conservation of VMO inclusion

Slide 10

Results: for Mini-SV Less blood misfortune Less agony day 1 Earlier SLR 90° achieved sooner (factually critical)

Slide 11

Disadvantages of Mini-SV More tourniquet time More intricacies (one every): PT burst Lateral condyle crack Varus tibial segment Initial understanding

Slide 12

Limitations of MIS Inflammatory joint pain Restricted flexion (under 80°) Patella infera (IS-R < 0.6) Morbid corpulence (BMI > 35.0) Risk of ischemic skin complexities Very serious disfigurements (more than 20°) Large strong guys

Slide 13

Hypothesis Could we get similar MIS focal points with a shorter however more routine approach, with not so much confusions but rather more accuracy ?

Slide 14

Limited ParaPatellar Quad entry point 5 cm above patella No patellar eversion

Slide 15

Femur first: distal cut from foremost (with scaled down instrument)

Slide 16

Femoral segment measuring/pivot

Slide 17

Femoral a/p cuts (cut back cutting piece)

Slide 18

Tibial cut with tibia subluxed forward (EM cutting dance)

Slide 19

Complete tibial presentation for an assortment of tibial inserts

Slide 20

Fluted High flex portable RP Mini-bottom TM

Slide 21

Limited ParaPatellar versus Mini-Subvastus approach Prospective coordinated case-control concentrate Same embed (LPS) and multimodal torment administration Limited ParaPatellar – 30 TKA Mini-subvastus – 30 TKA Sensi-Aglietti, submitted to KSSTA 2007

Slide 22


Slide 23


Slide 24

Clinical outcomes Subjective

Slide 25

Clinical outcomes Objective

Slide 26

Radiographic outcomes

Slide 27

Mini-SV radiographic "blemishes" Tibial medialization Retained concrete

Slide 28

1. Conclusion The Mini-Subvastus had simpler recuperation however a greater number of inconveniences and more tourniquet time than the Traditional Parapatellar approach.

Slide 29

2. Conclusion Less obtrusive TKA is not for everyone: it has numerous impediments or contraindications.

Slide 30

3. Conclusion The Limited ParaPatellar was just somewhat substandard compared to the Mini-Subvastus in the main weeks after surgery, yet with less tourniquet time and enhanced radiographic outcomes.

Slide 31

4. Conclusion Outcome of TKA is multifactorial: "Less obtrusive" surgical system Preop understanding training with clear desires Postoperative torment control Rehabilitation

Slide 32

5. Conclusion "Less intrusive" system: Reduced QT cut No patella eversion No tibial subluxation ?

Slide 33

6. Conclusion The "less obtrusive idea" is setting down deep roots. It has invigorated new specialized arrangements, with little savvy instruments and new surgical abilities.

Slide 34

Risks and advantages Comfort zone for the specialist

Slide 35

The significance of being MIS M inimally IS M edium IS M aximally IS