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TKA Prosthesis Design
Posted: Aug 31 2022 #(C102080)
A

Knee Osteoarthritis in 80M

HPI

A 80-year-old male presents with a 10-year history of left knee pain that has worsened over the last 5 years. He has pain with walking, climbing stairs, and twisting. He also complains of stiffness, swelling and weakness. He has tried NSAIDs, PT, and injections and continues to be symptomatic. He can no longer go for walks in the morning, and has difficulty driving due to knee pain.

PMH

PMH: arrhythmia, HTN, melanoma, sleep apnea

PE

Focused physical examination reveals a varus knee with tenderness to palpation over the medial joint space. There is patellofemoral crepitation with pain. The knee range of motion is 5-120º. There is mild laxity with correctable varus deformity. He is neurovascularly intact.

Poll
1 of 8
1. In addition to plain film radiographs of the knee, would you obtain further imaging to guide management?
No - current radiographs are sufficient
49%
390/788
Yes - additional Radiographic Views (aXR)
34%
270/788
Yes - CT scan of the knee (CT)
2%
22/788
Yes - MRI of the knee (MRI)
7%
58/788
Yes - aXR + CT
0%
3/788
Yes - aXR + MRI
2%
18/788
Yes - CT + MRI
0%
5/788
Yes - aXR + CT + MRI
0%
2/788
Outside my area of expertise - best if I don't vote
2%
20/788
2. How would you manage the patient at this time?
Nonoperative
3%
30/753
Operative
93%
702/753
Outside my area of expertise - best if I don't vote
2%
21/753
3. If you choose Arthroplasty, what procedure would you perform?
I would not choose Arthroplasty
1%
10/771
Total knee arthroplasty (TKA)
75%
584/771
Unicompartmental arthroplasty (UKA)
17%
136/771
Bicompartmental knee arthroplasty
3%
24/771
Will decide after visualizing compartments
0%
2/771
Outside my area of expertise - best if I don't vote
1%
15/771
4. If you choose Total Knee Arthroplasty (TKA), what would you do with the PCL?
I would NOT choose TKA
3%
25/704
Sacrifice the PCL
48%
340/704
Retain the PCL
39%
277/704
Partial release of the PCL
5%
37/704
Outside my area of expertise - best if I don't vote
3%
25/704
5. If you choose TKA AND Sacrificed the PCL, what type of bearing design would you use?
I would not choose TKA AND Sacrifice the PCL
13%
89/663
Fixed - standard bearing with POST
46%
306/663
Fixed - standard bearing without Post
8%
57/663
Fixed - Medial Stabilized bearing (medial pivot, medial congruence)
16%
108/663
Mobile - with POST
6%
40/663
Mobile - without POST
2%
16/663
Outside my area of expertise - best if I don't vote
7%
47/663
6. If you choose TKA, would you plan on resurfacing the patella?
I would not choose TKA
1%
8/684
No
24%
168/684
Yes
49%
340/684
Depends on intraoperative findings
21%
150/684
Outside my area of expertise - best if I don't vote
2%
18/684
7. If you choose Total Knee Arthroplasty (TKA), what technology would you use for implant positioning/balancing?
I would not choose TKA
1%
9/690
No Technology - Traditional Guides only
62%
428/690
Navigation (NAV) Alone
8%
57/690
Robotic assisted Navigation (ROBOT) Alone
13%
92/690
Patient Specific Instrumentation (PSI)
5%
37/690
Sensors (Sensor)
0%
4/690
Yes - Combination of above
2%
16/690
Outside my area of expertise - best if I don't vote
6%
47/690
8. If you choose TKA, what chemical anticoagulation would you use postoperatively?
I would not choose TKA
1%
11/691
None
1%
8/691
Aspirin (any dose)
35%
246/691
Low molecular weight heparin (ie. Lovenox)
40%
280/691
Direct factor Xa inhibitors (ie. Rivaroxaban, Apixaban, Fondaparinux, etc.)
18%
127/691
Warfarin (ie. Coumadin)
0%
1/691
Outside my area of expertise - best if I don't vote
2%
18/691
PROCEDURE #1

Left total knee arthroplasty

POLL#
Surgeon's Choices
1
In addition to plain film radiographs of the knee, would you obtain further imaging to guide management?
No - current radiographs are sufficient
2
How would you manage the patient at this time?
Operative
3
If you choose Arthroplasty, what procedure would you perform?
Total knee arthroplasty (TKA)
5
If you choose Total Knee Arthroplasty (TKA), what would you do with the PCL?
Partial release of the PCL
6
If you choose TKA AND Sacrificed the PCL, what type of bearing design would you use?
Fixed - Medial Stabilized bearing (medial pivot, medial congruence)
8
If you choose TKA, would you plan on resurfacing the patella?
Yes
9
If you choose Total Knee Arthroplasty (TKA), what technology would you use for implant positioning/balancing?
No Technology - Traditional Guides only
10
If you choose TKA, what chemical anticoagulation would you use postoperatively?
Aspirin (any dose)
icon
OUTCOMES
Post-procedure P1
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