1. Revision Knee Arthroplasty CLINICAL CASES
LEGION Revision Knee System
Revision Knee Arthroplasty CLINICAL CASES
by Marc CLEMENS MD & Yvan BARTHOLOME MD

2. Clinical Cases 3 clinical cases 3 different problems
Learning time and complications
Discussion

3. Clinical Cases Clinical cases - 3 different problems
1 - Allergy - Bone defect
2 - Osteolysis
3 - Classical TKA revision Patellar sub-dislocation

4. C. Simone Woman - 71 years old Surgical past : Patellar fracture
Case 1
Woman - 71 years old
Surgical past :
Patellar fracture

5. C. Simone Woman - 71 years old Surgical past :
Case 1
Woman - 71 years old
Surgical past :
1998 Total Knee Arthroplasty (Nickel-Chrome-Cobalt)

6. C. Simone Woman - 71 years old Surgical past :
Case 1
Woman - 71 years old
Surgical past :
Allergy - Nickel !!!

7. C. Simone Woman - 71 years old Surgical past :
Case 1
Woman - 71 years old
Surgical past :
Year Femoral revision Genesis II (Zirconium -3)

8. C. Simone Woman - 71 years old Surgical past :
Case 1
Woman - 71 years old
Surgical past :
Year Release of the Lateral Patellar Retinaculum (small sub-dislocation)

9. C. Simone Woman - 71 years old Surgical past :
Case 1
Woman - 71 years old
Surgical past :
2002 Cement “disease” Allergy +++

10. C. Simone Woman - 71 years old Surgical past : Year 2003
Case 1
Woman - 71 years old
Surgical past :
Year 2003
Tibial Revision (Full Poly - Size Max) Dermatologist error ! Allergy to Titanium

11. C. Simone Woman - 71 years old Surgical past :
Case 1
Woman - 71 years old
Surgical past :
Persistence of a large knee laxity Allergy

12. C. Simone Woman - 71 years old Now : Year 2007
Case 1
Woman - 71 years old
Now :
Year 2007
LEGION (Cement Simplex Antibiotic)

13. C. Simone Technical data
Case 1
Technical data
Femoral implants: Legion Oxinium size 4 Stem 18 mm x 120 mm L-wedge 10 mm dist (x2) 10 mm post
Patellar implant: 26 mm biconvex
Tibial implants: Legion baseplate size 3 6 mm offset coupler Stem 22 mm x 120 mm 21 mm posterior stabilized articular insert

14. C. Simone Woman - 71 years old Post operative incident :
Case 1
Woman - 71 years old
Post operative incident :
Year week post-op
LEGION
Fracture under the TKA

15. H. Lucienne
Case 2
Woman - 73 years old
Surgical past :
1975
Maquet

16. H. Lucienne Woman - 73 years old Surgical past : 1979 Tibial Osteotomy
Case 2
Woman - 73 years old
Surgical past :
1979
Tibial Osteotomy

17. H. Lucienne
Case 2
Woman - 73 years old
Surgical past :
1987
Emslie

18. H. Lucienne Woman - 73 years old Surgical past : 1990
Case 2
Woman - 73 years old
Surgical past :
1990
Pseudarthosys of TTO

19. H. Lucienne Woman - 73 years old Surgical past : 1992 Arthroscopy
Case 2
Woman - 73 years old
Surgical past :
1992
Arthroscopy

20. H. Lucienne Woman - 73 years old Surgical past : 1993
Case 2
Woman - 73 years old
Surgical past :
1993
Total Knee Arthroplasty
(Freeman - cemented femoral implant - uncemented tibial implant)

21. H. Lucienne Woman - 73 years old Surgical past : 1994 TKA Revision
Case 2
Woman - 73 years old
Surgical past :
1994
TKA Revision
(Patella pain - femoral implant)

22. H. Lucienne Woman - 73 years old Before our operation :
Case 2
Woman - 73 years old
Before our operation :
Recurvatum Pain Tibial osteolysis

23. H. Lucienne Woman - 73 years old Now :
Case 2
Woman - 73 years old
Now :
TKA Revision Legion - Offset

24. H. Lucienne Technical data
Case 2
Technical data
Femoral implants: Legion Oxinium size 4 6 mm offset coupler Stem 15 mm x 160 mm L-wedge 15 dis x 5 pos Wedge 5 mm
Patellar implant: 29 mm biconvex
Tibial implants: Legion baseplate size 3 6 mm offset coupler Stem 15 mm x 220 mm 15 mm posterior stabilized articular insert

25. H. Albert
Case 3
Man - 71 years old
Surgical past :
1991
Arthroscopy

26. H. Albert Man - 71 years old Surgical past : 2002
Case 3
Man - 71 years old
Surgical past :
2002
Quadriceps tendon pulling up

27. H. Albert Man - 71 years old Surgical past : 2006
Case 3
Man - 71 years old
Surgical past :
2006
Total Knee Arthroplasty
(Tibial osteolysis, medial rotation, patellar sub-dislocation)

28. H. Albert
Case 3
Man - 71 years old
Now :
2007
TKA Revision
Legion

29. H. Albert Technical data
Case 3
Technical data
Femoral implants: Legion Oxinium size 7 Stem 18 mm x 160 mm L-wedge 10 dis x 5 pos L-wedge 5 dis x 5 pos
Patellar implant: 29 mm biconvex
Tibial implants: Legion baseplate size 7 Stem 16 mm x 160 mm 13 mm posterior stabilized articular insert

30. LEGION Revision Knee System
Conclusion
For the tibial insert: This revision system is based on an intramedullary guide. Post scriptum : the anatomic axis approached the mechanical axis to within 1° on average in both the anteroposterior and lateral planes.
Bono JV, Roger DJ, Laskin RS, Peterson MGE,Paulsen CA. Tibial intramedullary alignment in total knee arthroplasty. 1998;13(2):241.

31. LEGION Revision Knee System
Conclusion
It’s not like other revision knee systems where the direction of the tibial base plate restricted by the bone defects (+ grafts) determines the axis of the stem.
In such case, the use of long implants transfers stress from the deficient plateau to the shaft and might cause significant periarticular stress shielding.
Diaphyseal engaging stem causing malalignment in a tibia with valgus bowing.
Thomas K. Fehring. Use of Stems in Revision Total Knee Arthroplasty. Revision Total Knee Arthroplasty. James V. Bono. Richard D. Scott Editors. 2005;13:

32. LEGION Revision Knee System
Conclusion
With the LEGION Revision Knee System, it’s necessary to have optimal length and width of stem to obtain a stable primary fixation.
To restore the anatomical axis of the tibial plateau; offset couplers, hemi-angled, hemi-stepped, full-angled or full-step wedges are available.

33. LEGION Revision Knee System
Conclusion
This complex LEGION Revision Knee System allows the re-establishment of a balanced biomechanical knee arthroplasty and a favourable distribution of the stress shielding on the bone.

34. LEGION Revision Knee System
Conclusion
In practice : Use preferably long stem than small and large stem to have a good distribution of loads

35. LEGION Revision Knee System
Conclusion
14mm 13mm 11mm 14mm
Reamer size
-1 mm
In case of : press-fit stem and osteoporosys of small bone cortical take an implant 1 mm narrower than the last reamer size to avoid excessive constraints on bone structures.

36. LEGION Revision Knee System
Conclusion X
When you have assembled the tibial base trial, the offset coupler and the stem, NEVER USE A HAMMER with the tibial baseplate impactor to insert the trial into the tibia.

37. LEGION Revision Knee System
Conclusion
USE the LONG STEM EXTRACTOR TOOL and THE UNIVERSAL EXTRACTOR to avoid compressing the trial J-hook system and assess wrongly the correct length of the stem.

38. LEGION Revision Knee System
Conclusion
All these conclusions are particularly valid in case of : - old patient - obesity - osteoporosys - large bone defect - tibial implant

39. Thank You for your attention
LEGION Revision Knee System
Thank You for your attention