surgical technique

Surgical Technique

ApproachRevision TKR Tibial Lysis

 

Incision

 

Always use the most lateral scar

- blood supply comes from medial aspect

- want to avoid a large lateral flap of dubious quality

- cross transverse scars at 90o

- minimum 7 cm skin bridge

 

Options

- can do trial / sham incision down to capsule

Patella Resurfacing

Options

 

1. Always resurface

2. Never resurface

3. Selectively resurface

 

Decision Making

 

Controversial

- literature divided on issue

 

Historically

- poor outcomes due to poor implant design

- now improved designs

- non resurfacing also improved due to better design and improved techniques in regard to tracking and rotation

 

Oxford Technique

PreoperativeUKA Oxford AP

 

Indications

- anteromedial disease

- patient points to anterior medial joint line only as source of pain

 

Pre-op x-rays

- AP and lateral

- Rosenberg to assess lateral joint

- long leg AP view to assess alignment

 

Pre-op examination

Quadriceps Tendon Rupture

Epidemiology

 

Usually occurs in patients over 60

- due to decreased vascularity & collagen weakness

 

Younger patient on steroids / growth hormone

 

Occasionally occurs in young athlete with excessive contracture

 

Aetiology

 

Often preceded by quadriceps tendinosis