Ebook A beginner ’s guide to total knee replacement: Part 2

(BQ) Part 2 book “A beginner ’s guide to total knee replacement” hass contents: Instruments for primary total knee replacement, postoperative treatment, mobilization and physiotherapy, fixed varus and valgus deformities, tricks and tips with mediolateral deformities, recurvatum deformity of the knee,… and other contents.

Instruments for Primary Total Knee Replacement 253 10 Instruments for Primary Total Knee Replacement I rrespective of the implant design or brand, the instruments achieve exactly the same goals, namely: Cutting the lower femur in a few degrees valgus and parallel to the floor Cutting the upper tibia neutral to floor mediolaterally but with a slight posterior slope Ensuring a proper rotational alignment during anterior, posterior and chamfer cuts of distal femur The surface and taper cuts of distal femur should exactly match the undersurface of the femoral component Adequate trials for checking all cuts and releases before implantation Instrumentation to ensure that gaps in flexion and extension are equal 253 254 Guide to Total Knee Replacement CHARNLEY FEMORAL BROACH The intramedullary broach and alignment rod is available in different combinations from the simplest to the most complicated This is the first instrument used and locates the long axis of the femur The rod should be inserted deep enough into the medulla to catch the isthmus to ensure that a wrong axial identification is avoided The distal femoral cutting guide is attached to this block Instruments for Primary Total Knee Replacement 255 DISTAL FEMORAL CUTTING ASSEMBLY Various designs of distal cutting blocks achieve the same purpose with minor technical variations in the instrumentation 256 Guide to Total Knee Replacement EACH SYSTEM PROVIDES A VALGUS CUT Each instrument can provide valgus cuts from 3° to 7° in small increments to tailor the cut according to the patient Instruments for Primary Total Knee Replacement 257 BLOCK DESIGNS VARY These blocks can vary from simple Freeman and Insall designs (top and bottom) to the complex fourth generation magnetic snap-on jigs 258 Guide to Total Knee Replacement THE UPPER TIBIAL CUTTING GUIDE The upper tibial cutting guides too come in various designs They cut mm of upper tibia with a slight posterior slope Instruments for Primary Total Knee Replacement 259 STATIC GAP EVALUATION DEVICES THEY CANNOT MEASURE MIDFLEXION GAPS The gap balancing can be either static or dynamic Static balancers are just spacers of different thicknesses which are tried in flexion and extension to ensure that the knee is neither too tight nor too wobbly 260 Guide to Total Knee Replacement DYNAMIC GAP BALANCING INSTRUMENTS The dynamic gap balancers expand the gap with a turn screw and even mid-range gaps can be measured Long-term success of a knee depends on proper gap balancing and equalization of tension in all quadrants Instruments for Primary Total Knee Replacement 261 FEMORAL COMPONENT SIZE MEASURING Each implant design has its own femoral size template It is useful to have a metal scale to correctly measure the cut dimensions and ensure that the right size implant is used 262 Guide to Total Knee Replacement THE FOUR-IN-ONE CUTTING BLOCK, COMMON TO ALMOST ALL DESIGNS The four-in-one cutting blocks the anterior, posterior, anterior chamfer and posterior chamfer cuts ... or broaches to match the tibial metalback 27 4 Guide to Total Knee Replacement Impactors for femur and tibia Instruments for Primary Total Knee Replacement 27 5 Block pins, extractors, angle... delayed exchange for infected total knee arthroplasty Am J Knee Surg 20 01; 14(1):60–4 Nendick M Patient satisfaction with post-operative analgesia Nurs St 20 00; 14 (22 ): 32 7 478 Guide to Total Knee. .. compartment knee osteoarthritis Ann Rheum Dis 20 02; 61(7):617 22 Mont MA, Fairbank AC, Yammamoto V, et al Radiographic characterization of aseptically loosened cementless total knee replacement Clin Orthop