Algorithm to correct Varus Knee in a TKR
- 1. The VARUS KNEE Dr Vaibhav Bagaria Sir HN Reliance Foundation Hosp Mumbai India
- 2. Surgical Anatomy Pes Anserinus Superficial MCL Deep MCL Joint Capsule Semi Membranous Posterior Oblique ligament
- 4. MCL
- 6. Goal - Symmetrical Gaps
- 7. What is a Varus Knee Maquet’s Line- Load Bearing Axis, Passes from centre of femoral head to Centre of Talus. Ideally through the centre of Knee Medial to Centre in case of Varus deformity
- 8. Maquet's Line Maquet’s Line- Load Bearing Axis, Passes from centre of femoral head to Centre of Talus
- 10. Case1
- 12. Case 2
- 13. Case 3
- 14. Case 4
- 15. Case 5
- 16. Medial Exposure Using Scalpel -Subperisoteal elevation of the medial sleeve Includes Joint Capsule and deep MCL Continue with perisoteal elevator to elevate till Meta-physeal flare of tibia. RanSall Manouveur: flexion- ER @ tibia
- 18. Step 1: Osteophytes Remove all osteophytes from Femur & Tibia as they can tent the medial soft tissue sleeve and consequently shorten the MCL. Remember to check the Posterior femoral condyle and Posteromedial tibia -> as they tighten extension gap.
- 20. Step 2: PCL Make sure PCL is resected before balancing PCL is 2ry medial stabiliser so care should be taken not to release the entire sleeve of the tibia because it may cause medial instability In CR PCL is left intact
- 21. PCL Release
- 23. Step 3: Semi Membranosus If the tightness remains medially, the semimembranosus and posteromedial capsule can be released off the proximal tibia.
- 25. Step 4 - Posterior Oblique Lig If the gap is tight only medially in the extension during varus valgus stress -> posterior Oblique Ligament can be subperiosteally released. Is best done in a figure of 4 position
- 27. Step 5: Superficial MCL Assess the flexion extension gap using Lamina Spreader/ Trial Component/ Spacer block - Varus Valgus. If tight in both - release sub-periosteally SMCL off proximal tibia but not completely of distal tibia
- 29. Pie Crusting AF PE ( Atrial fibrillation - Pulmonary Embolism)
- 33. step 6 Pes Release
- 34. Step 7: Shift and Resect Initial conservative tibial resection Based on lateral side: 10mm Angle perpendicular to long axis with 3 - 5 slope Measure for size of tray Downsize and lateralise
- 35. Shift & Resect
- 36. Shift & Resect
- 37. Shift & Resect
- 39. Residual LCL laxity IT band can usually dynamically restore the stability in most cases. 1st options: increase medial release/ medial cut and use thicker Poly 2nd: LCL advancement
- 40. Algorithm Create a Medial Subperiosteal Sleeve with DMCL Remove the osteophytes Take the cuts -remember ER may need to be increased Check the Gaps Release Semimembranosus, POL SMCL ant or Post Shift and Resect