Ortho Oracle - orthopaedic operative atlas

TKR: Surgical Approach

– Discussion:     – anterior longitudinal incision allows full exposure of the proximal tibia;           – this incision allows exposure of both medial & lateral aspects of joint w/o the necessity                     for large skin flaps;           – this incsion has advantage that … Read more

TKR: Rotational Alignment using AP Axis

– Discussion:     – see rotational alignment in TKR:     – rotational mal-alignment may lead to patellar malalignment and varus-valgus instability;     – valgus knee may have a lateral condyle which is deficient posteriorly;     – therefore, use of the posterior condyles as a reference, may lead to relative internal rotation of the … Read more

TKR: Removal of Posterior Osteophytes

– Discussion:     – remove any accumulation of osteophytes in posterior recesses with an osteotome or rongeur;            – pass a curved osteotome around each of posteior condyles, removing any overhanging bone or osteophytes;            – if left unresected, this overhanging bone can impinge on tibial plastic, limiting flexion and … Read more

TKR: Patellar Revision

– Discussion:  – in total knee replacement patients, patellectomy will decrease peak torque generated by the quadriceps by 20-40 %.  – in revising a TKR with a deficient patellar component, there is controversy as to whether a PCL retaining or posterior stabilized prosthesis should be used;  – w/ first generation posterior stabilized components, it was … Read more