Stefan Rahm MD University Hospital Balgrist
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1 Knee Prosthesis Models & Materials, Surgical Techniques and Approaches Stefan Rahm MD University Hospital Balgrist
2 INTRODUCTION
3 VARUS VALGUS
4 46 Y OLD MALE Pain in the medial compartment left more than right Status post 2 times partial medial meniscectomy Varus of 11 Medial unicompartmental osteoarthritis
5 46 Y OLD MALE MRI for evaluation of the lateral and patellofemoral compartment OPTIONS??
6 46 Y OLD MALE Conservativ: - Lateral shoesole raise - Corticosteroid Infiltration Operativ: - High tibial open wedge valgus osteotomy - Unicompartmental knee prosthesis
7 46 Y OLD MALE Medial unicompartmental Osteoarthritis Young and active, good lateral and patellofemoral compartment - High tibial open wedge valgus osteotomy Titanium Locking Plate (Tomofix)
8 63 Y OLD MALE Pain in the medial compartment both knees Varus left: 9 right: 7 Medial unicompartmental osteoarthritis
9 63 Y OLD MALE - Medial compartment Osteoarthritis - Middle aged - Good lateral and patellofemoral compartment - Intact anterior cruciate ligament OPTIONS??
10 63 Y OLD MALE Conservativ: - Lateral shoesole raise - Corticosteroid Infiltration Operativ: - High tibial open wedge valgus osteotomy - Unicompartmental knee prosthesis
11 63 Y OLD MALE Unicompartmental medial knee prosthesis Approach: Standard anteromedial
12 UNICOMPARTMENTAL KNEE PROSTHESIS Ideal Patient:* ** - Over 60 y - Low demand - Under 80 kg - Full extension - 90 degrees flexion - < 10 varus and - < 15 valgus * Pearse AJ et al. JBJS Br 2009 ** Berger RA et al. JBJS 2005
13 UNICOMPARTMENTAL KNEE PROSTHESIS Survivorship 70 to 98 % after 10 years* / ** * Australian Orthopaedic Association National Joint Replacement Registry 2010 Annual Report. Table KP29. Page 102. ** Price AJ et al. CORR, 2005
14 UNICOMPARTMENTAL KNEE PROSTHESIS SUMMARY: - Only medial or lateral compartment osteoarthritis - Stable ligaments - Shorter rehab than with total knee arthroplasty (TKA) - Osteoarthritis can go on -> revision to TKA* - Not for younger active patients (revisionrate 19% in patients under 55y after 7 years) - Results of TKA after Uni worse ** Berger RA et al. JBJS 2005 ** Pearse AJ et al. JBJS Br 2009
15 PATELLOFEMORAL JOINT PROSTHESIS
16 PATELLOFEMORAL JOINT PROSTHESIS High revision rate Rare indication Results lately better
17 82 Y FEMALE
18 SURGICAL APPROACH FOR TOTAL KNEE ARTHROPLASTY (TKA)
19 PERSONALIZED CUTTING BLOCKS
20 PERSONALIZED CUTTING BLOCKS
21 PERSONALIZED CUTTING BLOCKS
22 PERSONALIZED CUTTING BLOCKS
23 PERSONALIZED CUTTING BLOCKS
24 82 Y FEMALE
25 83 Y MALE
26 COMPUTER ASSISTED SURGERY Intraoperative pictures of computer navigation. An imageless computer navigation systemshowing the computer screen and infrared camera. Pointer for anatomic registration points
27 TOTAL KNEE ARTHROPLASTY Intraoperative pictures of computer navigation using... Femoral cutting block with navigator Validation of femoral cut with tracker
28 83 Y MALE
29 TOTAL KNEE ARTHROPLASTY Conventionel Technique: Computer-navigation: Individuel patient-specific technique: standard preciser (less outliers) even preciser* * MacDessi SJ et al. The Knee, 2014
30 MATERIAL Femur component (usually cemented) (cobalt-chrome-molybdenum stainless steel) Ultra highly crosslinked Polyethylen Inlay Tibia component (always cemented) (cobalt-chrome-molybdenum stainless steel)
31 TOTAL KNEE ARTHROPLASTY (TKA) Miller MD et al. Review of Orthopaedics, 2012 c
32 TYPES OF PRIMARY TOTAL KNEE ARTHROPLASTY Cruciate retaining Cruciate sacrificing Posterior stabilized Anterior stabilized
33 TYPES OF PRIMARY TOTAL KNEE ARTHROPLASTY Semiconstrained TKA
34 TYPES OF PRIMARY TOTAL KNEE ARTHROPLASTY Highly constrained TKA
35 TOTAL KNEE ARTHROPLASTY Patella resurfacing?
36 TOTAL KNEE ARTHROPLASTY - Less range of motion - Limited activity - Pain 10-20%!!! - Survivalship Unknown reason!
37 TOTAL KNEE ARTHROPLASTY COMPLICATIONS Survival of the prosthesis: after 5 y 95%!!! after 10 y 91% after 15 y 84% after 20 y 78% Roberts VI et al. JBJS Br, 2007
38 TOTAL KNEE ARTHROPLASTY COMPLICATIONS Sadoghi P et al. Journal of Arthroplasty, 2013
39 TOTAL KNEE ARTHROPLASTY COMPLICATIONS Painful TKA: Rule out. - Infection - Instability - Loosening - Implant malposition Sadoghi P et al. Journal of Arthroplasty, 2013
40 REVISION PROSTHESIS Revision prosthesis Resultats worse than primary total knee arthroplasty
41 UNICOMPARTMENTAL KNEE PROSTHESIS 66 y old female: status post acl reconstruction, tuberositas osteotomy and unicompartmental medial kneeprosthesis 16 years ago with aseptic loosening
42 REVISION Revision with RT plus Solution knee prosthesis (highly constrained = rotating hinge)
43 77 Y MALE Aseptic loosening of a primary knee prosthesis 12 years ago Loosened screw causing massive..
44 Metallosis 77 Y MALE
45 77 Y MALE Revision with a highly constrained (rotating hinge) LINK knee prosthesis
46 81 Y FEMALE
47 81 Y FEMALE
48 76 Y MALE
49 76 Y MALE
50 74 Y FEMALE
51 74 Y FEMALE REVISION BECAUSE OF INSTABILITY
52 REVISION - ARTHRODESIS
53 THANK YOU
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