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TheOsteoarthriticKnee
BestCurrentPracticeinEuropePlanning+ExcludingInfectionP.RitschlOrthopedicClinicGersthof,Vienna
KeyPoints-planningOpenEKAMeeting–Florence20131Diagnosis/Knee-History/Examination5Technicalconsiderationforcorrectimplantation2Softtissuemanagment3Bonelossmanagment4Selectionofanappropriateprosthesis
Diagnosis/Knee-History/ExaminationUnderstandingoffailuremechanismofinitialTKAWhatstructuresarelost/deficient
SofttissuemanagmentSkin(scarformation,multiplepriorincisions)Exposure/ExtensormechanismStatusoftheligaments
Planningoftheincision–IncaseofPre-existingscarsNotransverseincisionIncorporateverticalscarsRespect2:1rulethelengthofparallelincisionsshouldnotexceedthedoubleofthedistancefromeachotherCrossingpreviousscars:angle60°Usethemostrecentlyhealedorthemostlateralincisionforreasonableexposure(mostsignificantbloodsupplyfrommedial)ThicksubfascialskinflapsVinceKG;CORRNov;452:88-90.12
Exposure/ExtensormechanismStiffkneeExtensionlag(ruptureofthepatellaligament/rectustendon)Patelladislocation+/-fractureQuadricepssnipOsteotomyofthetibialtubercleTendonreconstruction-augmentationprocedures(LARS)Plan
StatusoftheligamentsSelectionofanappropriateprosthesesExtentofInstability:varus/valgusanteroposteriorglobal
Planning:LevelofConstraintA/PVar/ValgUltracongruent(+)-Rotationgplatform(+)-Post.Stabilized(+)-CCKType+(+)RotatingHinge++
BonelossManagmentLMF1F2AF2BF3EstimateextentofbonelossSelectionofanappropriateprostheses
Contained(cavitary)SmalluncontainedLargeuncontainedBoneCement(+)Smalldefects(+)Smalldefects-MorsellizedBoneGrafts+--StructuralBoneGrafts-++MetallAugments-++CustommadeProstheses--+Planning:Extentofboneloss
TechnicalconsiderationforcorrectimplantationEquipmentofimplantremovalJointlineTe
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