– Optimize the Exposure: – it is important to fully expose the proximal tibial surface inorder to avoid iatrogenic injury to the collateral ligaments, the PCL, or even the posterior neurovascular structures; – soft tissue stripping: (see medial and lateral capsular exposure) … Read more
– Techique: – preparation and exposure for the proximal tibial cut: – hyperflexion of the knee to allows the vessels to fall more posteriorly; – curved knee retractors are positioned anterior to mid-coronal plane, so that patella tendon and MCL will not … Read more
– 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
– 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
– Discussion: – the patella should evert with minimal tension on the patella tendon; – methods to facilitate patellar eversion: – patellar resurfacing: – patellar resurfacing can be performed early in the exposure inorder to thin the patella … Read more
– See: Patella in TKR – Discussion: – indications for patellar resurfacing – patellar malalignment – lateral retinacular release – Technique: – start by everting the patella laterally and reflecting the fat pad & synovium from around its periphery; – remove any overhanging osteophytes; – … Read more
– See: TKR: Soft Tissue Balance and Collateral Ligaments – Discussion: – fixed varus is the most common angular contracture in pts undergoing tkr; – this deformity may be accentuated by the presence of medial tibial plateau or medial femoral condyle osteophytes; – it is essential that … Read more
– See: – Total Knee Replacement: – High Tibial Osteotomy: – TKR following HTO: – expected problems following an HTO may include: – patellar infera – peripatellar scarring (and inability to evert the patella); … Read more
– Discussion: – may result from unequal flexion and extension gaps; (instability in extension or flexion due to MCL or LCL incompetence); – varus subluxation in extension or flexion due to unequal gaps; – in the report by Fehring TK, et al, the authors evaluated the causes of revision … Read more
– See: – TKR Menu – blood supply to the knee: – standard lateral retinacular release: – Discussion: – at completion of TKR, patellar tracking are critically evaluated to insure stability; – patellar tracking may be improved by removal of patellar osteophytes … Read more