PCL CONTROVERSY IN TKR - SSTAPCL的争论在TKR型.ppt

* * * * * * * * 4. Conclusion Outcome of TKA is multifactorial: “Less invasive” surgical technique Preop patient education with clear expectations Postoperative pain control Rehabilitation 5. Conclusion “Less invasive” technique: Reduced QT incision No patella eversion No tibial subluxation ? 6. Conclusion The “less invasive concept” is here to stay. It has stimulated new technical solutions, with small smart instruments and new surgical skills. Risks and benefits Comfort zone for the surgeon The importance of being MIS Minimally IS Medium IS Maximally IS * * * * * * * * * * * * * * * * * * * * * * * * * * * Prof. P Aglietti Director of the First Orthopaedic Clinic University of Florence, Italy MIS TKA today Promises, promises…… Less trauma Less pain Less blood loss Faster rehabilitation Better cosmesis Prospective, matched case-control study Implants: LPS (stemmed tibial component) Analgesia: femoral nerve block + PCEA Mini-Subvastus vsTraditional Medial ParaPatellar Boerger-Aglietti, CORR 2005 Mini-Subvastus – 60 TKA Traditional Medial ParaPatellar – 60 TKA L-shaped capsular incision Mini-Subvastus Limited blunt dissection over the septum Tibia first (in situ) Patella not everted Distal cut from medial Exposure of both condyles Complete preservation of VMO insertion Less blood loss Less pain day 1 Earlier SLR 90° reached sooner (statistically significant) Results: in favor of Mini-SV More tourniquet time More complications (one each): PT rupture Lateral condyle fracture Varus tibial component Initial experience Disadvantages of Mini-SV Inflammatory arthritis Restricted flexion (less than 80°) Patella infera (IS-R 0.6) Morbid obesity (BMI 35.0) Risk of ischemic skin complications Very severe deformities (more than 20°) Large muscular males Limitations of MIS Could we obtain the same MIS advantages with a shorter but more conventional approach, with less complications and