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

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 • Javad Parvizi, MD • Fred Cushner, MD • Amar S. Ranawat, MD • David F. Dalury, MD

Complex Case • 68 yo male • 8 years following right medial UKA – Weight bearing pain – Recurrence of “bow- leg” – ESR/CRP neg – Aspiration negative

Pre-op Planning and Surgical Options • Surgical Exposure • Component Removal • Bone Preparation – Bone loss consideration • Implant Choice – Primary Components – Revision Components • Stems • Augments • Constraint

Pre-op Planning and Surgical Options • Surgical Exposure • Component Removal • Bone Preparation – Bone loss consideration • Implant Choice – Primary Components – Revision Components • Stems • Augments • Constraint

Distal condylar bone graft to contained medial defect

PS primary femur with stemmed tibial component

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

Left Knee Radiographs

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

Post-op Radiographs

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

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

Exam Under Anesthesia

Intra-op Exam

Rotating Hinge Prosthesis

Post-op Radiographs

Complex Case • 64 yo healthy female – Left knee pain – Scope x 3 – Night pain / rest pain • Left Primary TKA – Cemented PS – CCK insert used

Following TKA new onset pain weight bearing pain 6 weeks 16 months

What to do • ESR / CRP normal • Knee aspiration negative • Pre-op Plan: – Any other test – Diagnosis – Prosthesis type • Stems • Augments • Constraint

Operative Findings • Femur grossly loose • Posterior condylar bone loss – Distal femoral augmentation – Posterior augments

Post-op Radiographs

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

Complex Revision TKA • 79 year old female • Exam – Left Knee: Midline incision • Effusion • Medial tenderness • AROM 0° - 135° • Medial laxity • Quad strength 5/5

Pre-op Radiograph Left Knee

What to do • Tibial bone loss • Implant Choice – Stems – Augments – Constraint

Intra-op Solution

Post-op Radiographs

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

Pre-op

What to do • Surgical exposure – Standard medial parapatella arthrotomy – Quad snip – V-Y turndown – Tibial tubercle osteotomy • What about prior hardware • Implant choice

Post-op Radiograph

Complex Case • 89 yo female • 15 yrs s/p bilateral TKA • Doing great, living independently

Bilateral supracondylar femur fractures

What to do • Medical Issues • Orthopedic Issues

Staged Distal Femoral Replacement (1 week apart)

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