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TKR: Femoral Component Notching

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- Discussion:
    - notching may occur with the anterior femoral cut;
    - classification: 4 grades using the Tayside classification:
            - grade I: violation of the outer table of the anterior femoral cortex;
            - grade II: violation of the outer and the inner table of the anterior femoral cortex;
            - grade III: violation up to 25% of the medullary canal (from the inner table to the center of the medullary canal);
            - grade IV: violation up to 50% of the medullary canal (from the inner table to the center of the medullary canal) and unclassifiable.
   - consequences of notching the femur:
            - supracondylar periprosthetic femoral fracture
            - Lesh ML, et al (2000): authors performed a biomechanical study to determine  consequences of notching the femur;
                   - authors noted that femoral notching significantly lessens the load to failure following TKR and influences the subsequent fracture pattern;
                   - they recommended great care in the postop PT for these patients and recommended that these patients should not be subjected to knee manipulation; 
                   - The consequences of anterior femoral notching in total knee arthroplasty. A biomechanical study.
                   - The Effect of Femoral Notching During Total Knee Arthroplasty on the Prevalence of Postoperative Femoral Fractures and on Clinical Outcome.

- Risk of periprosthetic fracture after anterior femoral notching.

- Notching of the anterior femoral cortex during total knee arthroplasty characteristics that increase local stresses.

- Improved stability with intramedullary stem after anterior femoral notching in total knee arthroplasty

 


- References: