Planning a total knee arthroplasty Lecture AO Recon

Learning objectives • • Describe the principles of alignment Describe the x-ray views to

Anatomical alignment • Goal: tibial cut with 3°varus = medial slope • Why 3°medial

Gait cycle Standing on both legs 6 Weight bearing: centering of the leg under

Which x-rays? Is appropriate planning possible? 7

Which x-rays? Navigation/PSI Full-length hip-to-ankle AP weight-bearing view 8

Which x-rays? • Evaluation of ligaments? AP stress view • Unicondylar vs bicondylar knee

Which x-rays? Rosenberg view Melnic et al (J Orthopedics Rheumatol, 2014; 2(1): 6) 10

Which x-rays? Rosenberg view Melnic et al (J Orthopedics Rheumatol, 2014; 2(1): 6) 11

Which x-rays? • Important for planning and choice of implant design • Varus-valgus constrained:

Deformity—intraarticular Correction with bone resection 15

Deformity—extraarticular No correction possible with a bone resection ligament instability 16

Deformity—extraarticular No correction possible with a bone resection ligament instability 1. Osteotomy with Center

Preoperative planning? 1. Cutting plane 2. Femoral valgus cut angle 3. Femoral entry point

Preoperative planning? 1. 2. 3. 4. 19 Cutting plane Femoral valgus cut angle Femoral

Preoperative planning? 1. 2. 3. 4. Cutting plane Femoral valgus cut angle Femoral entry

Take-home messages • Anatomical alignment: • 3° tibial varus cut = medial slope •

Planning a total knee arthroplasty Lecture

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Planning a total knee arthroplasty Lecture AO Recon Course—Principles of Total Hip and Knee Arthroplasty

Disclosure 2

Learning objectives • • Describe the principles of alignment Describe the x-ray views to obtain Recognize deformities/malalignment Describe the steps in a total knee arthroplasty (TKA) templating 3

Gold standard? 90° 4 90° - 95°

Anatomical alignment • Goal: tibial cut with 3°varus = medial slope • Why 3°medial slope at the tibia? 5

Gait cycle Standing on both legs 6 Weight bearing: centering of the leg under the upper body

Which x-rays? Is appropriate planning possible? 7

Which x-rays? Navigation/PSI Full-length hip-to-ankle AP weight-bearing view 8

Which x-rays? • Evaluation of ligaments? AP stress view • Unicondylar vs bicondylar knee replacement Beaufils et al 9

Which x-rays? Rosenberg view Melnic et al (J Orthopedics Rheumatol, 2014; 2(1): 6) 10

Which x-rays? Rosenberg view Melnic et al (J Orthopedics Rheumatol, 2014; 2(1): 6) 11

Which x-rays? Patella 12

Which x-rays? Patella 13

Which x-rays? • Important for planning and choice of implant design • Varus-valgus constrained: • Linked femoral and tibial components (hinged) • Prosthesis allows rotational stability 14

Deformity—intraarticular Correction with bone resection 15

Deformity—extraarticular No correction possible with a bone resection ligament instability 16

Deformity—extraarticular No correction possible with a bone resection ligament instability 1. Osteotomy with Center of Rotation and Angulation (CORA) method 2. TKA implantation: 1 - or 2 -stage procedure 17

Preoperative planning? 1. Cutting plane 2. Femoral valgus cut angle 3. Femoral entry point 18

Preoperative planning? 1. 2. 3. 4. 19 Cutting plane Femoral valgus cut angle Femoral entry point Tibial slope (posterior-cruciate retaining vs posterior-stabilized)

Preoperative planning? 1. 2. 3. 4. Cutting plane Femoral valgus cut angle Femoral entry point Tibial slope (posterior-cruciate retaining vs posterior-stabilized) 5. Implant size 20

Take-home messages • Anatomical alignment: • 3° tibial varus cut = medial slope • X-ray views: • Full-length hip-to-ankle AP weight-bearing view • AP stress view • Patella view • Rosenberg view • Extraarticular deformity: no correction possible with bone resection CORA method 21

Planning a total knee arthroplasty Lecture