CASE PRESENTATION- hOW TO PERFORM total knee replacement surgery in Ankylosed and stiff kneeppt

how to perform TKR in stiff knee

1. CASE PRESENTATION- STIFF
KNEE
Dr Akshat Vijay
M.S.(Orth.), D.N.B.(Orth.), M.N.A.M.S.
Consultant Orthopaedics, Getwell Superspeciality Centre, Kota

2. CASE DETAILS-
•56 Years old female.
•K/C/O CLD with HTN with Hypothyroidism; poor compliance for T/t.
•Had proximal tibia fracture 4 years back; m/t conservatively
elsewhere.
•Operated for left I/T Femur by me 1 year back.
•Presented with c/o inability to walk since last 4 years, bed ridden,
going to washroom and fulfilling daily work by crawling.
•Diagnosed as B/L OA knee KL Grade 4 with healed fracture left
proximal tibia with severe osteopaenia with healed ipsilateral I/T
Femur with implant in situ.

3. PRE OPERATIVE EXAMINATION
•Severe tenderness along medial and lateral joint line.
•Patella fixed, no gliding.
•Knee ROM-no movement, fixed stiff knee in 5-10 degree flexion.
•Severe tibia shin pain present.
•SLR test, active- 30-40 degree with fixed flexed knee.
•Inflammatory signs- negative.
•No translation and coronal or saggital movements at proximal tibia
fracture site.
•I/L Hip and ankle movements normal.

4. PRE OPERATIVE RADIOGRAPHS

5. PRE OPERATIVE RADIOGRAPHS

6. INTRAOPERATIVE STEPS
•Medial parapatellar approach
•Patellofemoral osteotomy in extension
•Proximal tibial cut of 7 mm in extension, to take off bone cake and
make space for knee flexion and instrumentation.
•Adhesions along femur and quadriceps release till isthmus.
•Medial and lateral gutters cleared, retinaculum release.
•Std medial release extending to superficial MCL.
•IT Band pie crusting
•Rectus snip

7. INTRAOPERATIVE STEPS-
•Implant details-
•Extension rod- 10.5*100
•Femur component- C
•Tibia Component-2
•Poly-17

8. INTRAOPERATIVE PICS
FLEXION EXTENSION

9. INTRAOPERATIVE PICS
Intraoperative extension-
Full, no lag remaining
Intraoperative Flexion-
50 Degree before arthrotomy closure
30 to 40 Degree after final skin closure

10. POST OPERATIVE RADIOGRAPH

11. FOLLOW UP
Last F/U- 2months from Sx; Ext- full, Flexion –
20 to 30 degree, SLR active- 70 Degree; able to
walk with walker, carry out all household
activites by herself, planning for C/L TKR; not
ready to underwent any physio till date.