Transcript legion - CHIRURGIE

LEGION
Revision Knee System
Revision Knee Arthroplasty
CLINICAL CASES
by
Marc CLEMENS MD
&
Yvan BARTHOLOME MD
Clinical Cases
• 3 clinical cases
• 3 different problems
• Learning time and complications
• Discussion
Clinical Cases
• Clinical cases - 3 different problems
• 1 - Allergy - Bone defect
• 2 - Osteolysis
• 3 - Classical TKA revision
Patellar sub-dislocation
Case 1
C. Simone
• Woman - 71 years old
• Surgical past :
Patellar fracture
Case 1
C. Simone
• Woman - 71 years old
• Surgical past :
1998
Total Knee Arthroplasty
(Nickel-Chrome-Cobalt)
Case 1
C. Simone
• Woman - 71 years old
• Surgical past :
1998 - 2000
Allergy - Nickel !!!
Case 1
C. Simone
• Woman - 71 years old
• Surgical past :
Year 2000
Femoral revision
Genesis II
(Zirconium -3)
Case 1
C. Simone
• Woman - 71 years old
• Surgical past :
Year 2001
Release of the
L Patellar Retinaculum
ateral
(small sub-dislocation)
Case 1
C. Simone
• Woman - 71 years old
• Surgical past :
2002
Cement “disease”
+
Allergy +++
Case 1
C. Simone
• Woman - 71 years old
• Surgical past :
Year 2003
Tibial Revision
(Full Poly - Size 15
- Max)
Dermatologist error !
Allergy to Titanium
Case 1
C. Simone
• Woman - 71 years old
• Surgical past :
Persistence of a large knee laxity
+
Allergy
Case 1
C. Simone
• Woman - 71 years old
• Now :
Year 2007
LEGION
(Cement Simplex
Antibiotic)
Case 1
C. Simone
• Technical data
• Femoral implants:
Legion Oxinium size 4
Stem 18 mm x 120 mm
L-wedge 10 mm dist
(x2)
10 mm post
• Patellar implant:
26 mm biconvex
• Tibial implants:
Legion baseplate size 3
6 mm offset coupler
Stem 22 mm x 120 mm
21 mm posterior
stabilized articular
insert
Case 1
C. Simone
• Woman - 71 years old
• Post operative incident :
Year 2007
1 week post-op
LEGION
Fracture under
the TKA
Case 2
H. Lucienne
• Woman - 73 years old
• Surgical past :
1975
Maquet
Case 2
H. Lucienne
• Woman - 73 years old
• Surgical past :
1979
Tibial Osteotomy
Case 2
H. Lucienne
• Woman - 73 years old
• Surgical past :
1987
Emslie
Case 2
H. Lucienne
• Woman - 73 years old
• Surgical past :
1990
Pseudarthosys of TTO
Case 2
H. Lucienne
• Woman - 73 years old
• Surgical past :
1992
Arthroscopy
Case 2
H. Lucienne
• Woman - 73 years old
• Surgical past :
1993
Total Knee Arthroplasty
(Freeman - cemented femoral implant
- uncemented tibial implant)
Case 2
H. Lucienne
• Woman - 73 years old
• Surgical past :
1994
TKA Revision
(Patella pain - femoral implant)
Case 2
H. Lucienne
• Woman - 73 years old
• Before our operation :
Recurvatum
Pain
Tibial osteolysis
Case 2
H. Lucienne
• Woman - 73 years old
• Now :
2007
TKA Revision
Legion - Offset
Case 2
H. Lucienne
• Technical data
• Femoral implants:
Legion Oxinium size 4
6 mm offset coupler
Stem 15 mm x 160 mm
L-wedge 15 dis x 5 pos
Wedge 5 mm
• Patellar implant:
29 mm biconvex
• Tibial implants:
Legion baseplate size 3
6 mm offset coupler
Stem 15 mm x 220 mm
15 mm posterior
stabilized articular insert
Case 3
H. Albert
• Man - 71 years old
• Surgical past :
1991
Arthroscopy
Case 3
H. Albert
• Man - 71 years old
• Surgical past :
2002
Quadriceps tendon
pulling up
Case 3
H. Albert
• Man - 71 years old
• Surgical past :
2006
Total Knee Arthroplasty
(Tibial osteolysis, medial rotation,
patellar sub-dislocation)
Case 3
H. Albert
• Man - 71 years old
• Now :
2007
TKA Revision
Legion
Case 3
H. Albert
• Technical data
• Femoral implants:
Legion Oxinium size 7
Stem 18 mm x 160 mm
L-wedge 10 dis x 5 pos
L-wedge 5 dis x 5 pos
• Patellar implant:
29 mm biconvex
• Tibial implants:
Legion baseplate size 7
Stem 16 mm x 160 mm
13 mm posterior
stabilized articular insert
LEGION
Revision Knee System
Conclusion
For the tibial insert:
This revision system is based on an
intramedullary guide.
Post scriptum : the anatomic axis
approached the mechanical
axis to within 1° on average
in both the anteroposterior and
lateral planes.
Bono JV, Roger DJ, Laskin RS, Peterson MGE,Paulsen CA.
Tibial intramedullary alignment in total knee arthroplasty. 1998;13(2):241.
LEGION
Revision Knee System
Conclusion
It’s not like other revision knee systems
where the direction of the tibial base
plate restricted by the bone defects (+
grafts) determines the axis of the stem.
In such case, the use of long implants
transfers stress from the deficient
plateau to the shaft and might cause
significant periarticular stress shielding.
Thomas K. Fehring. Use of Stems in Revision Total Knee Arthroplasty.
Revision Total Knee Arthroplasty. James V. Bono. Richard D. Scott Editors. 2005;13:137-144
Diaphyseal engaging stem
causing malalignment in
a tibia with valgus bowing.
LEGION
Revision Knee System
Conclusion
With the LEGION Revision Knee System,
it’s necessary to have optimal length
and width of stem to obtain a stable
primary fixation.
To restore the anatomical axis of the tibial
plateau; offset couplers, hemi-angled,
hemi-stepped, full-angled or full-step
wedges are available.
LEGION
Revision Knee System
Conclusion
This complex LEGION Revision Knee System allows
the re-establishment of a balanced biomechanical
knee arthroplasty and a favourable distribution of
the stress shielding on the bone.
LEGION
Revision Knee System
Conclusion
In practice :
Use preferably
long stem
than
small and large stem
to have a good
distribution of loads
LEGION
Revision Knee System
Conclusion
• In case of :
press-fit stem and
osteoporosys of
small bone cortical
-1 mm
take an implant 1 mm
narrower than the last
reamer size to avoid
excessive constraints
on bone structures.
Reamer size
14mm
13mm
11mm
14mm
LEGION
Revision Knee System
Conclusion
• When you have
assembled the tibial
base trial, the offset
coupler and the stem,
NEVER USE A
HAMMER with the
tibial baseplate
impactor
to insert the trial into
the tibia.
X
LEGION
Revision Knee System
Conclusion
• USE the
LONG STEM EXTRACTOR TOOL
and THE UNIVERSAL EXTRACTOR
to avoid compressing
the trial J-hook system
and assess wrongly the correct length of
the stem.
LEGION
Revision Knee System
Conclusion
• All these conclusions are particularly
valid in case of :
- old patient
- obesity
- osteoporosys
- large bone defect
- tibial implant
LEGION
Revision Knee System
Thank You for your attention