How to Interpret Postoperative X- ray after Total knee arthroplasty.pptx

Reading X ray after Total knee arthroplasty is an art. Certain points that one should focus on are discussed here along with x rays

1. How to read Postoperative X- ray after Total Knee Arthroplasty DR. LOKESH CHUGH SENIOR RESIDENT DEPT. OF ORTHOPAEDICS GMC, AMRITSAR.

2. AIMS OF TKR NEUTRAL MECHANICAL AXIS RESTORATION OF JOINT LINE PAINLESS MOBILE AND STABLE JOINT

3. LONG FILM X RAY- SCANOGRAM IDEAL MECHANICAL AXIS Not always available Costly

4. SHORT FILM X- RAY AFTER TKR Is it ok!!

5. CORONAL PLANE ALIGNMENT PARALLEL MEDIAL LATERAL JOINT LINE

6. CORONAL PLANE ALIGNMENT MEDIAL DISTAL FEMORAL ANGLE = 95 DEGREE MEDIAL PROXIMAL TIBIAL ANGLE = 90 DEGREE

7. CORONAL PLANE ALIGNMENT FFC 2-7 DEGREE VALGUS FTC <3 DEGREE VARUS

8. RESTORING JOINT LINE 23 MM FROM LATERAL FEMORAL EPICONDYLE 28 MM FROM MEDIAL FEMORAL EPICONDYLE 15 MM FROM FIBULAR HEAD

9. RESTORING JOINT LINE EASY IN PRIMARY DIFFICULT IN REVISION DIFFICULT TO LOCALISE MALE AND FEMALE VARIATIONS

10. ADDUCTOR TUBERCLE JOINT LINE ONE CONSTANT LANDMARK DEPENDENT ON FEMORAL CONDYLAR WIDTH RATIO= ATJL/FW=0.52

11. RESTORING JOINT LINE IN REVISION TKR MEASURE FEMORAL CONDYLAR WIDTH MULTIPLY WITH 0.52, CALCULATE ATJL DISTAL FEMORAL CUTTING BLOCK FIXED AT ATJL AFTER PUTTING INTRAMEDULLARY JIG ASSESS AND SELECT APPROPRIATE SIZE OF AUGMENT

12. FEMORAL COMPONENT OVER HANG- NOT DESIRED MEDIAL OVERHANG- NO APPROPRIATE SIZE

13. FEMORAL COMPONENT APPROPRIATE SIZE NO NOTCHING SHENTON’S LINE INTACT POSTERIOR CONDYLAR OFFSET

14. FEMORAL COMPONENT- ALIGNMENT NEUTRAL NO FLEXION NO EXTENSION

15. POSTERIOR CONDYLAR OFFSET POSTERIOR CONDYLAR OFFSET =AB PCO RATIO = AB/AC

16. FEW WORDS ABOUT FEMORAL NOTCHING – GUJARATHI GRADING GRADE 1 – OUTER TABLE OF ANTERIOR CORTEX GRADE 2 – OUTER AND INNER TABLE OF ANTERIOR CORTEX

17. FEMORAL NOTCHING – GUJARATHI GRADING GRADE 3-violation of upto 25% of medullary canal GRADE 4-violation of upto 50% of medullary canal

18. FEMORAL COMPONENT- CR/ PS POSTERIOR STABILISED BONE LOSS/CUT CAM AND POST NOT VISIBLE ON X RAY

19. FEMORAL COMPONENT- CR CRUCIATE RETAINING NO BONE CUT ONLY PEGS FOR FIXATION NO BOX IN FEMORAL COMPONENT

20. FEMORAL COMPONENT CEMENTATION CEMENTATION

21. TIBIAL COMPONENT OVER HANG MEDIAL OVERHANG - NO IN CASE NEEDED LATERAL - ACCEPTABLE NO MEDIAL OVERHANG

22. TIBIA COMPONENT SIZE- APPROPRIATE NO POSTERIOR OVERHANG

23. POSTERIOR TIBIAL SLOPE 5 DEGREE No posterior overhang

24. CEMENTATION

25. PATELLA – SKYLINE VIEW Skyline view- patellar thickness Patellar tracking M L

26. INSALL SALVATI RATIO PATELLAR TENDON/ PATELLAR LENGTH NORMAL = 0.8 – 1.2

27. PATELLA BAJA INSALL SALVATI RATIO < 0.8 Contracted patellar tendon.

28. Instability of patellofemoral joint Skyline view- patella in trochlear groove Patellar tilt more than 5 degree- patellofemoral instability

29. ASEPTIC LOOSENING Radiological evaluation-SCORING 1-2 medial plateau 3-4 lateral plateau 5-7 stem fixation

30. ASEPTIC LOOSENING Radiological evaluation-SCORING Lateral view- FEMORAL SIDE 1-2 anterior flange 3-4 posterior area 5-7 stem or central portion

31. ASEPTIC LOOSENING Radiological evaluation-SCORING Skyline view of patella 1 medial side 2 lateral side 3-5 fixation lugs (central)

32. INTERPRETATION FROM RADIOLOGICAL EVALUATION

33. Risk factors of Heterotropic Ossification Pre existing HO Hypertrophic OA Ankylosing spondylitis DISH Surgical factors- splitting quadriceps tendon, striping of soft tissue on anterior aspect femur

34. Heterotropic ossification 1- upto 5 cm 2 2- more than 5cm 2 3- 2+near femur, restricts knee flexion, needs surgery visible on x ray after 5 weeks.

35. Risk factor for fracture periprosthetic fracture Osteopenia Osteolysis. PE wear Component loosening Anterior femoral notching Malalignment

36. THANK YOU