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TKR Technique: Tibial Component



- Tibial Component Preparation:
 - ACL is resected, w/ or w/o PCL preservation;
 - Extramedullary Guides
   - alignment is made w/ jig parallel to ant crest of tibia shaft.
   - referencing was taken off the lateral tibial plateau.
 - Proximal Tibial Resection
   - Determine appropriate Posterior Slope
   - Depth of Tibial Cut:
      - 2 mm resection is selected off less involved condyle;
      - Joint Line Position is maintained;
      - menisci were removed medially and laterally.
      - tibial cut is then performed w/ soft tissue protection using spade retractor and care taken to avoid cutting straight post to avoid 
           injury to PCL or neurovascular structures.
      - wide osteotome is then used to complete cut posteriorly bilaterally & proximal tibial bone resection removed w/ a knife to release 
           soft tissue from the bone;
- Assess need for Bone Grafts:
- Seating of the Tibial Tray
  - be aware of Rotation of Tibial Component & avoid Internal Rotation of Tibial Component
  - trial tibial tray that does not overhang medially is placed;
  - trial insert in placed ( > 8 mm)
- Alignment:
 - standard tibial tray was checked w/ the long alignment rod and is noted to pass thru the 2nd metatarsal of the foot.
 - Tray is removed & the cruciate keel punch is then placed.
      - tibia is prepared w/ Hall bur w/ 2 posterior holes placed
 - Trial w/ cruciate keel (stem) is then placed and again avoid Internal Rotation of Tibial Component
- Trial Reduction:
 - Trial reduction is performed w/ Poly spacer & femoral component.
 - Flexion Contracture of TKR:
     - strip posterior capsule;
 - Assess Flexion & Extension Gaps
     - need for further resection of distal femur
     - need for more Posterior Slope versus more prox tibia resection