How I Do a TKR

---

How I Do a TKR Thomas P. Schmalzried, M.D. Joint Replacement Institute St. Vincent Medical Center Harbor-UCLA Orthopaedics

Disclosure • • • •

Royalty: DePuy; Stryker Patent Holder: DePuy; Stryker Consultant: DePuy; Stryker Speakers’ Bureau: DePuy; Stryker

Primary TKR Overview

• Blood banking • Osteotomy v. Uni. v. Bi v. TKR • Approach • Anesthesia / pain • Navigation / imaging • Fixation • Bearings • Patellar resurfacing • VTED • Rehab. • Post-op. activity • Follow-up

Technique Classic Principles • Mid-line incision • Parapatellar arthrot. • Cut distal femur (neutral axis) • Cut tibia minimal slope (PS) • Balance in extension lamina spreaders spacer blocks

Technique • Flex to 900 • Tension ligaments • Position AP guide for rectangular flexion gap

Lateral

Define the FE Axis for That Knee Rotational checks: 1. Posterior; take more medial

2. Trans-epicondylar axis Grand Piano Sign

3. Anterior; take more lateral

Technique • Tibial component position A. Coverage B. External rotation

• Longitudinal alignment

Patellar tracking is a product of 3-D femoral component and tibial component positioning

Technique • Cement Fixation “seal” the interface cement the keel • PS design - controlled roll-back • Minimal bone resection • Open box

Clean all cement from the box

“No thumbs” test for patella tracking

Patient R.L. • 59 y.o. male • Professional Golfer • R>>L pain • Mechanical symptoms on L

Patient M.E. • 78 y.o. male • Hispanic immigrant • L>R • No history of trauma • Poor balance and coordination • Lateral thrust • Decreased pulses

Patient M.L.

• 46 y.o. female • Hispanic immigrant • 2 yrs. s/p tibial plateau fracture • Lateral knee pain

Patient D.C. • 44 y.o. male • Chronic L knee pain • s/p Hauser • s/p patellectomy • 6 mos. s/p TKR Pain and stiffness

Patient V.J.

• • • • •

56 y.o. female X-ray tech. Work comp. s/p B TKR L>R knee pain

Patient J.T. • 48 y.o. male • Disabled work comp. • Multiple R TKR’s • Recurrent Instability • Anterior mass • 15° extensor lag • 6’4”, 260#