Planning knee replacement on xrays

Total Knee Replacement planning is a key factor in success of the surgery. Failing to plan is planning to Fail.

1. PLANNING & TEMPLATE
VAIBHAV BAGARIA
Joint Replacement Surgeon
Sir HN Reliance Foundation Hospital
Girgaum, Mumbai

2. GOALS
•Well Aligned
•Well Balanced
•Linear Patellar Tracking
•Infection free healing

3. EXPECTATIONS
•REDUCE PAIN
•IMPROVE FUNCTION
•IMPROVE QUALITY OF LIFE

4. PREOPERATIVE WORKUP
•PATIENT SELECTION
•PREOP MEDICAL ASSESMENT
•CLINICAL EXAM
•RADIO EXAM
•IMPLANT SELECTION
•COUNSELLING AND CONSENTING

5. TECHNICAL GOALS
•RESTORATION OF THE NEUTRAL
MECHANICAL ALIGNMENT
•PRESERVATION ( RESTORATION) OF JOINT
LINE
•PERIARTICULAR LIGAMENT BALANCING
•MAINTAING LINEAR PATELLAR TRACKING
AND Q ANGLE

6. IMAGING
•STANDARD AP/ LAT/ SKYLINE VIEWS
•SCANNOGRAM - PREFERABLE BUT NOT
MANDATORY

7. SCANNOGRAM
•EXTREMES OF HEIGHT
•ALTERED HIP/FEMORAL NECK ANATOMY:
DYSPLASIA, TRAUMA, INFECTION,
PREVIOUS OPERATION
•OBVIOUS CLINICAL DEFORMITY OF TIBIA
AND FEMORAL SHAFTS

8. SUPPLEMENTARY IMAGING
•TUNNEL VIEW: POSTERIOR WB SURFACE,
OCD, LOOSE BODIES
•CT/MRI: COMPLEX PRIMARY FOLLOWING
TRAUMA, DYSPLASIA, ALTERED BONE
STOCK OR PATIENT SPECIFIC
INSTRUMENTATION

9. What to see?
•Determine the femoral & tibial cuts and cut angles
•Position of the femoral canal entry point
•Anticipating the ligament release
•Identifying the bone defects, joint subluxation or lig
laxity
•Tempting prosthetic components

10. AP View
•Joint Compartments affected & Deformity
•Osteophytes: Imp for releases
•Evidence of previous surgery
•Alignment & Templating

11. Lateral view
•Flexion deformity
•Osteophytes
•Alignment
•Subchondral sclerosis
•Vessels

12. On femur: FAA, FMA, VCA
•Femoral Anatomical axis: Line that bisects the
Intramedulary canal
•Exit point determines the entry point of IM jig
•Draw Valgus Cut Angle: 5 - 7 degree decreasing
with patient height.
•VCA is perpendicular to femoral mechanical axis
( FMA)

14. Tibia
•Anatomic axis corresponds to Mechanical Axis
•IM or EM Jigs Used
•The cut is perpendicular to both
•If deformity MA is to be considered

15. Tibial Axis

30. QUIZ TIME

37. Take Home Message
•FAA
•TAA
•Valgus Cut
•Tibial Cut
•Osteophyte
•Implant Sizing & Positioning
Proper
preoperative
planning
prevents piss-
poor performance