Challenges in Revision TKA Case Presentations Moderators Giles R. - - PowerPoint PPT Presentation

▶
challenges in revision tka case presentations
SMART_READER_LITE
LIVE PREVIEW

Challenges in Revision TKA Case Presentations Moderators Giles R. - - PowerPoint PPT Presentation

Mar 12, 2023 327 likes •722 views

Challenges in Revision TKA Case Presentations Moderators Giles R. Scuderi, MD Douglas E. Padgett, MD The Panel Michael Bolognesi, MD William A. Jiranek, MD John J. Callaghan, MD Edward J.McPherson, MD Michael B. Cross, MD

slide-1
SLIDE 1

Challenges in Revision TKA Case Presentations

Moderators Giles R. Scuderi, MD Douglas E. Padgett, MD

slide-2
SLIDE 2

The Panel

  • Michael Bolognesi, MD
  • John J. Callaghan, MD
  • Michael B. Cross, MD
  • Fred Cushner, MD
  • David F. Dalury, MD
  • William A. Jiranek, MD
  • Edward J.McPherson, MD
  • Javad Parvizi, MD
  • Amar S. Ranawat, MD
slide-3
SLIDE 3

Complex Case

  • 68 yo male
  • 8 years following

right medial UKA

– Weight bearing pain – Recurrence of “bow- leg” – ESR/CRP neg – Aspiration negative

slide-4
SLIDE 4

Pre-op Planning and Surgical Options

  • Surgical Exposure
  • Component Removal
  • Bone Preparation

– Bone loss consideration

  • Implant Choice

– Primary Components – Revision Components

  • Stems
  • Augments
  • Constraint
slide-5
SLIDE 5

Pre-op Planning and Surgical Options

  • Surgical Exposure
  • Component Removal
  • Bone Preparation

– Bone loss consideration

  • Implant Choice

– Primary Components – Revision Components

  • Stems
  • Augments
  • Constraint
slide-6
SLIDE 6

Distal condylar bone graft to contained medial defect

slide-7
SLIDE 7

PS primary femur with stemmed tibial component

slide-8
SLIDE 8

Complex Revision TKA

  • 63 year old female
  • History

– Left TKA 1995 now symptomatic, sense of weakness and swelling – Right TKA 1996 asymptomatic – Infection work-up negative

  • Exam

– Left knee: midline incision; effusion; AROM 0° - 120°;

Medial lateral laxity; Increased AP translation > 10mm, Quad 5/5

– Right knee: midline incision; AROM 0° - 120°; stable; Quad 5/5

slide-9
SLIDE 9
slide-10
SLIDE 10

Left Knee Radiographs

slide-11
SLIDE 11

What to Do

  • Can this knee be treated non-operatively
  • If you are thinking surgery:

– Tibial polyethylene exchange

  • UC or CR

– Convert to PS – Revision to constrained implant

slide-12
SLIDE 12

Post-op Radiographs

slide-13
SLIDE 13

Complex Case

62 yo female 1 year following successful TKA falls Presents with painful unstable TKA

slide-14
SLIDE 14

What to do

1.Place the knee in a brace, suggest crutches for walking and begin physiotherapy 2.Perform a repair of the MCL 3.Release the lateral collateral ligament (LCL) and insert a thicker tibial component 4.Perform a revision to a constrained implant 5.Revise to a hinged prosthesis

slide-15
SLIDE 15

Exam Under Anesthesia

slide-16
SLIDE 16

Intra-op Exam

slide-17
SLIDE 17

Rotating Hinge Prosthesis

slide-18
SLIDE 18

Post-op Radiographs

slide-19
SLIDE 19

Complex Case

  • 64 yo healthy female

– Left knee pain – Scope x 3 – Night pain / rest pain

  • Left Primary TKA

– Cemented PS – CCK insert used

slide-20
SLIDE 20

Following TKA new onset pain weight bearing pain

6 weeks

16 months

slide-21
SLIDE 21

What to do

  • ESR / CRP normal
  • Knee aspiration negative
  • Pre-op Plan:

– Any other test – Diagnosis – Prosthesis type

  • Stems
  • Augments
  • Constraint
slide-22
SLIDE 22

Operative Findings

  • Femur grossly loose
  • Posterior condylar bone loss

– Distal femoral augmentation – Posterior augments

slide-23
SLIDE 23

Post-op Radiographs

slide-24
SLIDE 24

Complex Revision TKA

  • 79 year old female
  • History

– Bilateral TKA 1990 – Left revision TKA 1992 for loosening – Right revision TKA 1997 for loosening – Left knee now symptomatic with weight bearing and rest pain – Right knee asymptomatic – Infection work-up negative

slide-25
SLIDE 25

Complex Revision TKA

  • 79 year old female
  • Exam

– Left Knee: Midline incision

  • Effusion
  • Medial tenderness
  • AROM 0° - 135°
  • Medial laxity
  • Quad strength 5/5
slide-26
SLIDE 26

Pre-op Radiograph Left Knee

slide-27
SLIDE 27

What to do

  • Tibial bone loss
  • Implant Choice

– Stems – Augments – Constraint

slide-28
SLIDE 28

Intra-op Solution

slide-29
SLIDE 29

Post-op Radiographs

slide-30
SLIDE 30

Complex Revision TKA

  • 48 year old female
  • History

– Prior ORIF Left femur fracture – Left TKA 2005: post-op stiffness and loss of motion – Infection work-up negative

  • Exam

– Midline and lateral incision – AROM 0° - 30°; stable; Quad 5/5

slide-31
SLIDE 31

Pre-op

slide-32
SLIDE 32

What to do

  • Surgical exposure

– Standard medial parapatella arthrotomy – Quad snip – V-Y turndown – Tibial tubercle osteotomy

  • What about prior hardware
  • Implant choice
slide-33
SLIDE 33

Post-op Radiograph

slide-34
SLIDE 34

Complex Case

  • 89 yo female
  • 15 yrs s/p bilateral

TKA

  • Doing great, living

independently

slide-35
SLIDE 35

Bilateral supracondylar femur fractures

slide-36
SLIDE 36

What to do

  • Medical Issues
  • Orthopedic Issues
slide-37
SLIDE 37

Staged Distal Femoral Replacement (1 week apart)

slide-38
SLIDE 38

THANK YOU