Transcript Soft tissue Balancing In TKA Yazdi HR MD IUMS Tehran,Des, 2013

Do you do tis patient?
What is your approach?
How do you balance the knee?
Which implant do you prefer?
• Techniques : gap technique
and the measured resection
technique
• Gap technique may result
in residual varus alignment
in flexion( Whiteside et al)
•
Bone resections :according to
the preoperative template on
the long WB films
•
Tibial cutting jig :according to
the talus center distally
and
the plateau-to-anatomic axis
intersection proximally.
•
In constitutional metaphyseal
varus
deformities:
usually
facing the lateral tibial plateau
spine
•
•
•
medial flap of tissue, which includes the meniscotibial fibers of the
deep medial collateral ligament
sublux the tibia forward in flexion and external rotation (RanSall
maneuver)
violating the posterior tibial osteophyte(pagoda)
• tibial and femoral
osteophytes are
removed
• Do proximal
tibial and distal
femoral cuts
• Anteror and
posterior femoral
cuts
• Medial pivot if
needed
•PCL
•Posterior capsule
• Posteromedial corner with
the posterior oblique Ligament
(POL)
• Semimembranosus
(direct tibial insertion)
• Posterior fibers of the
superficial MCL
• All these structures can be
released with the knee in
Flexion
posterior capsule can be
addressed
by
a
periosteal elevator from
the femoral side.
figure four” position to
release SM and POL
• MCL
Pie-crusted with a 16 Gauge needle with
multiple Punctures
Distal release
Shift and resect technique
Effect of medial epicondylar osteotomy on soft
tissue balancing in total knee arthroplasty.
Mihalko WM, Saeki K, Whiteside LA.
• findings of this study question the need for an
epicondylar osteotomy in severe varus
osteoarthritic knees. Because the knee remains
unstable in flexion after this technique, an
implant with higher constraint should be used.
Orthopedics. 2013 Nov 1;36(11):e1353-7
Results of total knee arthroplasty with medial
epicondylar osteotomy to correct varus
deformity.
Engh GA, Ammeen D.
• The results show that epicondylar osteotomy
for varus knee deformity provides excellent
patient satisfaction, knee stability, motion,
and deformity correction.
Clin Orthop Relat Res. 1999 Oct;(367):141-8.
Medial epicondyle osteotomy: a method of
choice in severe varus knee arthroplasty
Horia Orban Gabriel Stan Mihaela Dragusanu Razvan Adam
Using medial epicondyle osteotomy for varus knee when performing
total knee arthroplasty could be a useful ligament-balancing technique
to achieve medial stability of the knee. In addition, it could have
considerable advantages towards the additional resection of the tibial
medial plateau.
European Journal of Orthopaedic Surgery & Traumatology
2012 | 22 | 7 | 579-583
A 65 Y/o F
Sever Bi varus deformity
End Results
Thank you