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Planning a total knee arthroplasty
Lecture Edited and updated, April 2019 by PD Dr. med. Philipp v. Roth AORecon Course—Principles of Total Hip and Knee Arthroplasty
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Disclosure
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Learning objectives Describe the principles of alignment
Describe the x-ray views to obtain Recognize deformities/malalignment Describe the steps in a total knee arthroplasty (TKA) templating
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Gold standard? 90° 90° - 95°
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Anatomical alignment Goal: tibial cut with 3°varus = medial slope
Why 3°medial slope at the tibia?
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Gait cycle Standing on both legs
Weight bearing: centering of the leg under the upper body
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Which x-rays? Is appropriate planning possible?
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Full-length hip-to-ankle AP
Which x-rays? Navigation/PSI Full-length hip-to-ankle AP weight-bearing view
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Which x-rays? Evaluation of ligaments? AP stress view
Unicondylar vs bicondylar knee replacement Reference: Beaufils et al. The Knee Joint. ???? Beaufils et al
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Which x-rays? Rosenberg view
Reference: Melnic et al. A Systematic Approach to Evaluating Knee Radiographs with a Focus on Osteoarthritis. J Orthopedics Rheumatol. 2014;2(1): 6. Melnic et al (J Orthopedics Rheumatol, 2014;2(1):6)
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Which x-rays? Rosenberg view
Reference: Melnic et al. A Systematic Approach to Evaluating Knee Radiographs with a Focus on Osteoarthritis. J Orthopedics Rheumatol. 2014;2(1): 6 Melnic et al (J Orthopedics Rheumatol, 2014;2(1):6)
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Which x-rays? Patella
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Which x-rays? Patella
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Which x-rays? Important for planning and choice of implant design
Varus-valgus constrained: Linked femoral and tibial components (hinged) Prosthesis allows rotational stability
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Deformity—intraarticular
Correction with bone resection
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Deformity—extraarticular
No correction possible with a bone resection ligament instability
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Deformity—extraarticular
No correction possible with a bone resection ligament instability Osteotomy with Center of Rotation and Angulation (CORA) method TKA implantation: 1- or 2-stage procedure
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Preoperative planning?
Cutting plane Femoral valgus cut angle Femoral entry point
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Preoperative planning?
Cutting plane Femoral valgus cut angle Femoral entry point Tibial slope (posterior-cruciate retaining vs posterior-stabilized)
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Preoperative planning?
Cutting plane Femoral valgus cut angle Femoral entry point Tibial slope (posterior-cruciate retaining vs posterior-stabilized) Implant size
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Take-home messages Anatomical alignment:
3° tibial varus cut = medial slope X-ray views: Full-length hip-to-ankle AP weight-bearing view AP stress view Patella view Rosenberg view Extraarticular deformity: no correction possible with bone resection CORA method
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