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When performing a total knee arthroplasty using intramedullary referencing, the knee is stable at full extension, but it will not flex past 90 degrees. Which of the following adjustments can achieve satisfactory range of motion and stability in flexion and extension?
Downsizing the tibial insert
Placing posterior femoral augments
Resecting more distal femur
Downsizing the femoral component
Performing a medial tibial reduction osteotomy
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All of the following are intraoperative techniques to treat a flexion contracture in total knee arthroplasty EXCEPT:
Release posterior capsule
Resect more distal femur
Downsize the femoral component
Tenotomize the hamstrings
After insertion of the trial components in a total knee replacement, the surgeon finds that he is unable to fully extend the knee and that the tibial tray lifts-off when the knee is flexed past 90 degrees. What intervention should be taken to achieve a knee that is balanced in flexion and extension?
Augment the distal femur
Resect more distal femur
Resect more proximal tibia
Increase polyethylene liner thickness
While performing a revision total knee arthroplasty, the surgeon decides to upsize the femoral component with use of posterior femoral augments. Which of the following intraoperative exam findings would have led to this decision?
A knee that is balanced in extension and tight in flexion.
A knee that is balanced in extension and loose in flexion.
A knee that is tight in extension and tight in flexion.
A knee that is loose in extension and loose in flexion.
A knee that is loose in extension and balanced in flexion.
A patient comes to the office with a flexion contracture following a total knee arthroplasty that has resulted in an unsatisfactory outcome. Intraoperative examination also reveals the knee is loose in flexion. What steps should be included in the revision surgery?
Increase the polyethylene liner thickness
Resect additional tibia
Anteriorly translate the femoral component and decrease polyethylene thickness
Resect additional distal femur and tibia
Resect additional distal femur and upsize the femoral component
During total knee arthroplasty, an excessive posterior femoral resection will lead to which of the following scenarios?
Loose extension and flexion gaps
Loose extension gap
Loose flexion gap
Tight flexion gap
Tight extension gap
A 78-year-old patient undergoing revision total knee arthroplasty has bone loss throughout the knee at the time of revision. A distal femoral augment is used to restore the joint line. One month after surgery, the patient reports pain and is unable to ambulate. A lateral radiograph is shown in Figure 34. What is the most likely etiology of this problem?
Inadequate restoration of the joint line
Patellar tendon rupture
Excessive internal rotation of the tibial component
Flexion gap instability
Hyperextension of the femoral component
After trial placement of components in a primary total knee arthroplasty, the knee is unable to come to full extension, but the flexion gap is appropriately balanced. After adequate soft-tissue releases have been performed, what is the next most appropriate action to balance the reconstruction?
Use a larger femoral component
Use a thinner polyethylene insert
Add posterior femoral augments
Resect additional distal femur
A 63-year-old woman reports giving way of the knee and pain after undergoing primary total knee arthroplasty (TKA) 1 year ago. Examination reveals that the knee is stable in full extension but has gross anteroposterior instability at 90 degrees of flexion. The patient can fully extend her knee with normal quadriceps strength. Studies for infection are negative. AP and lateral radiographs are shown in Figures 12a and 12b, respectively. What is the appropriate management?
Physical therapy for quadriceps strengthening
Revision to a thicker polyethylene insert
Revision to a larger, posterior stabilized implant
While trialing components during a routine total knee arthroplasty, the flexion gap is felt to be loose and the extension gap is stable. Which of the following are possible ways to treat this intraoperative instability?
Move the femoral component posterior
Increase the size of the polyethylene component
Downsize the femoral component
Move the femoral component anterior and augment the distal femur
Externally rotate both the femoral component and tibial components
A 62-year-old man undergoes total knee arthroplasty. Preoperative radiographs are shown in Figure A. Following bone resections and placement of trial implants, the knee is stable in flexion, but cannot achieve full extension. Which of the following interventions will most likely result in a knee that is balanced in flexion and extension?
Resect more distal femur and downsize the femoral component
Decrease polyethelene liner thickness
Place posterior femoral augments
During total knee replacement with the trial components in place, the knee achieves full extension but experiences tightness in flexion with a range to only 90 degrees. What is the most appropriate action?
Addition of a distal femoral augment
Downsize the tibial polyethylene insert
During trialing for a cruciate-sacrificing total knee arthroplasty, the surgeon notes an imbalance between the flexion and extension gaps with significant flexion instability. The extension gap is well balanced. Which of the following options is the best intra-operative solution?
Downsize the tibial component
Upsize the femoral component and add posterior augments
Upsize the tibial component
Move the femoral component more anteriorly
During trialing for a cruciate-retaining total knee arthroplasty, the surgeon is unable to fully extend the knee and is left with a 15 degree flexion contracture. The flexion gap is well balanced. Which of the following options will create a knee that is balanced in both flexion and extension?
Recess the PCL
Increase the tibial slope
Decrease the size of the femoral component
A 62-year-old woman is undergoing a revision total knee arthroplasty for aseptic component loosening. The surgeon has all the trial components in place and recognizes that the soft tissues are balanced in the coronal plane, but the knee is 10 degrees from reaching full extension. He proceeds to correct the contracture by making an additional 2mm cut off of the tibia and is successful in achieving full extension. What is the most likely effect of this additional resection?
Loss of full flexion
During a primary total knee arthroplasty, trial of components demonstrates a knee that is balanced in flexion and loose in extension. Which of the following will balance the flexion and extension gap?
Distal femur resection only
Distal femur augmentation and use of the same size polyethylene
Downsize femoral component and use a thinner polyethylene insert
Proximal tibia resection only
Distal femur augmentation and thicker polyethylene insert