(BQ) Part 1 book “A beginner ’s guide to total knee replacement” hass contents: Biomaterials of the artificial knee, the making of a knee prosthesis, biomechanical considerations, general principles of the surgical technique,… and other contents.
A Beginner’s Guide to Total Knee Replacement No sponsorship or benefits have been received from any commercial organization or company for production of this book This book does not advocate or propagate any particu-lar brand, design or company or their total knee joints or brand of bone cement That choice is left to the reader All profits from the sale of this book would be used for pure and applied research into normal and abnormal joints, and for performing surgeries on economically underprivileged patients L Prakash June 2016 A Beginner’s Guide to Total Knee Replacement L Prakash MS (Orth), M Ch (Orth) (Liverpool) Institute for Special Orthopaedics, Chennai, Tamil Nadu CBS Publishers & Distributors Pvt Ltd New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai Hyderabad • Nagpur • Patna • Pune • Vijayawada Disclaimer Science and technology are constantly changing fields New research and experience broaden the scope of information and knowledge The author has tried his best in giving information available to him while preparing the material for this book Although all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible some errors might have been left uncorrected The publisher, the printer and the author will not be held responsible for any inadvertent errors or inaccuracies A Beginner’s Guide to Total Knee Replacement ISBN: 978-93-85915-??-? Copyright © Author and Publisher First Edition: 2017 All rights reserved No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the author and the publisher Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt Ltd 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India Ph: 23289259, 23266861, 23266867 Website: www.cbspd.com Fax: 011-23243014 e-mail: delhi@cbspd.com; cbspubs@airtelmail.in Corporate Office: 204 FIE, Industrial Area, Patparganj, Delhi 110 092 Ph: 4934 4934 Fax: 4934 4935 e-mail: publishing@cbspd.com; publicity@cbspd.com Branches • Bengaluru: Seema House 2975, 17th Cross, K.R Road, Banasankari 2nd Stage, Bengaluru 560 070, Karnataka • • • • Ph: +91-80-26771678/79 Fax: +91-80-26771680 e-mail : bangalore@cbspd.com Chennai: 7, Subbaraya Street, Shenoy Nagar, Chennai 600 030, Tamil Nadu Ph: +91-44-26680620, 26681266 Fax: +91-44-42032115 e-mail: chennai@cbspd.com Kochi: Ashana House, No 39/1904, AM Thomas Road, Valanjambalam, Ernakulam 682 016, Kochi, Kerala Ph: +91-484-4059061-65 Fax: +91-484-4059065 e-mail: kochi@cbspd.com Kolkata: 6/B, Ground Floor, Rameswar Shaw Road, Kolkata-700 014, West Bengal Ph: +91-33-22891126, 22891127, 22891128 e-mail: kolkata@cbspd.com Mumbai: 83-C, Dr E Moses Road, Worli, Mumbai-400018, Maharashtra Ph: +91-22-24902340/41 Fax: +91-22-24902342 e-mail: mumbai@cbspd.com Representatives • Hyderabad 0-9885175004 • Pune 0-9623451994 Printed at • Nagpur • Vijayawada 0-9021734563 0-9000660880 • Patna 0-9334159340 Dedicated to Dr KH Sancheti The inventor of Indus Knee, my knee Guru and the person who taught me many things about knee joint Dedicated to Dr Raymon Gustilo, MD The Inventor of Genesis Knee, my old friend and a brilliant Orthopaedic teacher Foreword I first met Dr L Prakash around twenty seven years back, when he was doing a live demonstration of a cemented total knee replacement and I was moderating the session in the hall with a live video broadcast before over a hundred surgeons There was no doubt that he was an exceptional surgeon, because few dare to operate on a complex case in the presence of a live audience The surgery went off well; he was almost an artist, the tissues seemed to part before his fingers Despite not using a tourniquet, everything was clear and the audience gave a standing ovation The interesting part was that the surgery was completed in forty minutes even while he was explaining each step in detail and performing the knee replacement in an unhurried manner I still remember it was a complex rheumatoid knee with gross fixed flexion and varus deformities That evening in the banquet we had an interesting conversation “Prakash! You must write a book An atlas rather Explain your master techniques in detail.” “Well Venkat! You know my workload Where I have the time? So many patients and such a long list of patients waiting for surgery.” “And Prakash, when you the book, it should have excellent drawings Not black and white ones Proper colour ones like F H Netter illustrations.” “Venkat! That is the main difficulty Where will I find an artist like that? I need an artist who is a surgeon himself and can illustrate things better than a photograph Maybe if I get a proper artist, I’ll it Probably after my retirement!” Last week when I visited him in Chennai, I got a wonderful surprise This book was almost ready, and I was given the pleasant task of writing its foreword The illustrations were really good, the operative pictures exceptionally clear, and the multimedia videos really educative I have great pleasure in presenting this book to orthopaedic surgeons of the world Written like a graphic novel, with 90% Guide to Total Knee Replacement pictures and 10% text, this book is a pleasure to read, while full of knowledge Dr L Prakash has himself painted water colours for all pictures and the photos are from his own cases taken by his assistant He has himself edited the videos, and done part of the formatting and design of the book I was envious that one man could so many different things!! This book is a must-read for a surgeon planning to embark on the arduous but fascinating journey of becoming a primary knee arthroplasty surgeon It is also an essential read for those doing knee replacements, sporadically or occasionally For those doing it regularly, this will be an exceptional refresher, while it will be an invaluable addition to any operation theatre library Even an experienced arthroplasty surgeon like me could glean many valuable tips from this fascinating book Combining illustrations, photographs, videos and multimedia content is a brilliant idea and this book shows years of hard work and ceaseless toil to write It is with pride and pleasure that I write this foreword and dedicate the book to the orthopaedic fraternity S Venkateswaran Consultant Orthopaedic Surgeon North East London NHS Treatment Centre, King George Hospital, Ilford, Essex.IG3 8YY Ph: 0208 598 4600 Consulting Rooms in London & Birmingham 10 Harley Street, London, W1G 9PF Phone 02074678301 Guildhall Back Care Centre, Navigation Street, Birmingham B24BT Phone: 0121632 5332 238 Guide to Total Knee Replacement The anterior posterior and chamfer cuts Surgical Technique 239 Flexion and extension gap balance is the most important step of total knee replacement 240 Guide to Total Knee Replacement After removal of excess cement, the joint is thoroughly washed Surgical Technique 241 Towel clips will confirm that the patella does not tend to snap out during flexion 242 Guide to Total Knee Replacement The knee can be put through a full range of motion at this stage Surgical Technique 243 No deformities should be present now The knee should be extendable fully, be in slight valgus and lock steady in mediolateral axis 244 Guide to Total Knee Replacement The knee is now inspected carefully, washed thoroughly and all loose cement bits removed patiently Surgical Technique 245 The joint is again put through full range of movements with and without the towel clips 246 Guide to Total Knee Replacement REDUCTION, DRAIN, SUTURE AND BANDAGES The joint is again put through full range of movements with and without the towel clips Surgical Technique 247 The quadriceps mechanism is sutured by strong absorbable sutures A suction vacuum drain is inserted deep into the knee 248 Guide to Total Knee Replacement Subcutaneous absorbable sutures approximate the skin, which is closed by stapler application Surgical Technique 249 A sterile adhesive bandage is now pasted over the incision 250 Guide to Total Knee Replacement Cast padding and crepe bandage provide compression Surgical Technique 251 As mentioned previously, the total bone removed should not be more than the thickness of the two components 252 Guide to Total Knee Replacement A postoperative radiograph is taken for evaluation of component position ... Nagar, Chennai 600 030, Tamil Nadu Ph: + 91- 44-26680620, 266 812 66 Fax: + 91- 44-4203 211 5 e-mail: chennai@cbspd.com Kochi: Ashana House, No 39 /19 04, AM Thomas Road, Valanjambalam, Ernakulam 682 016 ,... replacement in old tuberculous knees 326 12 Guide to Total Knee Replacement 19 Total knee replacement in the haemophillic knee 335 20 Total knee replacement in the grossly unstable knee 337 21. .. pumice and POP as cement 8 Guide to Total Knee Replacement Macintosh tibial buttons Original implants from Dr Prakash’s collection Failure of Macintosh buttons at six years Surprising that it lasted