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

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Presentation on theme: "by Marc CLEMENS MD & Yvan BARTHOLOME MD Revision Knee Arthroplasty CLINICAL CASES LEGION Revision Knee System."— Presentation transcript:

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

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

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

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

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

7 Case 1 1998 - 2000Allergy - Nickel !!! C. Simone Woman - 71 years old Surgical past : Woman - 71 years old Surgical past :

8 C. Simone Woman - 71 years old Surgical past : Woman - 71 years old Surgical past : Case 1 Year 2000 Femoral revision Genesis II (Zirconium -3)

9 C. Simone Woman - 71 years old Surgical past : Woman - 71 years old Surgical past : Case 1 Year 2001 Release of the L ateral P atellar R etinaculum (small sub-dislocation)

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

11 C. Simone Woman - 71 years old Surgical past : Woman - 71 years old Surgical past : Case 1 Year 2003 Tibial Revision ( Full Poly - Size 15 - Max) Dermatologist error ! Allergy to Titanium Year 2003 Tibial Revision ( Full Poly - Size 15 - Max) Dermatologist error ! Allergy to Titanium

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

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

14 Femoral implants: Legion Oxinium size 4 Stem 18 mm x 120 mm L-wedge10 mm dist (x2)10 mm post Patellar implant: 26 mm biconvex Femoral implants: Legion Oxinium size 4 Stem 18 mm x 120 mm L-wedge10 mm dist (x2)10 mm post Patellar implant: 26 mm biconvex Technical data Tibial implants: Legion baseplate size 3 6 mm offset coupler Stem 22 mm x 120 mm 21 mm posterior stabilized articular insert Case 1 C. Simone

15 Woman - 71 years old Post operative incident : Woman - 71 years old Post operative incident : Case 1 Year 2007 1 week post-op LEGION Fracture under the TKA Year 2007 1 week post-op LEGION Fracture under the TKA

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

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

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

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

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

21 Case 2 1993 T otal K nee A rthroplasty (Freeman - cemented femoral implant - uncemented tibial implant) 1993 T otal K nee A rthroplasty (Freeman - cemented femoral implant - uncemented tibial implant) H. Lucienne Woman - 73 years old Surgical past : Woman - 73 years old Surgical past :

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

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

24 Case 2 2007 TKA Revision Legion - Offset H. Lucienne Woman - 73 years old Now : Woman - 73 years old Now :

25 Femoral implants: Legion Oxinium size 4 6 mm offset coupler Stem 15 mm x 160 mm L-wedge15 dis x 5 pos Wedge5 mm Patellar implant: 29 mm biconvex Femoral implants: Legion Oxinium size 4 6 mm offset coupler Stem 15 mm x 160 mm L-wedge15 dis x 5 pos Wedge5 mm Patellar implant: 29 mm biconvex Technical data Tibial implants: Legion baseplate size 3 6 mm offset coupler Stem 15 mm x 220 mm 15 mm posterior stabilized articular insert Case 2 H. Lucienne

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

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

28 Case 3 H. Albert Man - 71 years old Surgical past : Man - 71 years old Surgical past : 2006 T otal K nee A rthroplasty (Tibial osteolysis, medial rotation, patellar sub-dislocation) 2006 T otal K nee A rthroplasty (Tibial osteolysis, medial rotation, patellar sub-dislocation)

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

30 Femoral implants: Legion Oxinium size 7 Stem 18 mm x 160 mm L-wedge10 dis x 5 pos L-wedge5 dis x 5 pos Patellar implant: 29 mm biconvex Femoral implants: Legion Oxinium size 7 Stem 18 mm x 160 mm L-wedge10 dis x 5 pos L-wedge5 dis x 5 pos Patellar implant: 29 mm biconvex Technical data Tibial implants: Legion baseplate size 7 Stem 16 mm x 160 mm 13 mm posterior stabilized articular insert Case 3 H. Albert

31 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. Conclusion LEGION Revision Knee System Bono JV, Roger DJ, Laskin RS, Peterson MGE,Paulsen CA. Tibial intramedullary alignment in total knee arthroplasty. 1998;13(2):241.

32 Thomas K. Fehring. Use of Stems in Revision Total Knee Arthroplasty. Revision Total Knee Arthroplasty. James V. Bono. Richard D. Scott Editors. 2005;13:137-144 Its 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. Its 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. Conclusion LEGION Revision Knee System Diaphyseal engaging stem causing malalignment in a tibia with valgus bowing.

33 With the LEGION Revision Knee System, its 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. With the LEGION Revision Knee System, its 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. Conclusion LEGION Revision Knee System

34 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. Conclusion LEGION Revision Knee System

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

36 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. Conclusion Reamer size -1 mm 14mm 13mm 11mm 14mm LEGION Revision Knee System

37 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. Conclusion X X LEGION Revision Knee System

38 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. Conclusion LEGION Revision Knee System

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

40 Thank You for your attention LEGION Revision Knee System


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