by marc clemens md & yvan bartholome md revision knee arthroplasty clinical cases legion...
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by
Marc CLEMENS MD &
Yvan BARTHOLOME MD
by
Marc CLEMENS MD &
Yvan BARTHOLOME MD
Revision Knee ArthroplastyCLINICAL CASES
Revision Knee ArthroplastyCLINICAL CASES
LEGIONRevision Knee System
LEGIONRevision Knee System
Clinical Cases Clinical Cases
• 3 different problems• 3 different problems
• Learning time and complications• Learning time and complications
• Discussion• Discussion
• 3 clinical cases• 3 clinical cases
Clinical Cases Clinical Cases
• 1 - Allergy - Bone defect• 1 - Allergy - Bone defect
• 2 - Osteolysis • 2 - Osteolysis
• 3 - Classical TKA revisionPatellar sub-dislocation
• 3 - Classical TKA revisionPatellar sub-dislocation
• Clinical cases - 3 different problems• Clinical cases - 3 different problems
Case 1Case 1
Patellar fracturePatellar fracture
C. Simone C. Simone
• Woman - 71 years old
• Surgical past :
• Woman - 71 years old
• Surgical past :
Case 1Case 1
1998 Total Knee Arthroplasty(Nickel-Chrome-Cobalt)
1998 Total Knee Arthroplasty(Nickel-Chrome-Cobalt)
C. Simone C. Simone
• Woman - 71 years old
• Surgical past :
• Woman - 71 years old
• Surgical past :
Case 1Case 1
1998 - 2000 Allergy - Nickel !!!1998 - 2000 Allergy - Nickel !!!
C. Simone C. Simone
• Woman - 71 years old
• Surgical past :
• Woman - 71 years old
• Surgical past :
C. Simone C. Simone
• Woman - 71 years old
• Surgical past :
• Woman - 71 years old
• Surgical past :
Case 1Case 1
Year 2000 Femoral revisionGenesis II (Zirconium -3)
Year 2000 Femoral revisionGenesis II (Zirconium -3)
C. Simone C. Simone
• Woman - 71 years old
• Surgical past :
• Woman - 71 years old
• Surgical past :
Case 1Case 1
Year 2001
Release of the Lateral Patellar Retinaculum
(small sub-dislocation)
Year 2001
Release of the Lateral Patellar Retinaculum
(small sub-dislocation)
Case 1Case 1
2002 Cement “disease” +
Allergy +++
2002 Cement “disease” +
Allergy +++
C. Simone C. Simone
• Woman - 71 years old
• Surgical past :
• Woman - 71 years old
• Surgical past :
C. Simone C. Simone
• Woman - 71 years old
• Surgical past :
• Woman - 71 years old
• Surgical past :
Case 1Case 1
Year 2003
Tibial Revision(Full Poly - Size 15 - Max)
Dermatologist error !Allergy to Titanium
Year 2003
Tibial Revision(Full Poly - Size 15 - Max)
Dermatologist error !Allergy to Titanium
Case 1Case 1
Persistence of a large knee laxity+
Allergy
Persistence of a large knee laxity+
Allergy
C. Simone C. Simone
• Woman - 71 years old
• Surgical past :
• Woman - 71 years old
• Surgical past :
C. Simone C. Simone
• Woman - 71 years old
• Now :
• Woman - 71 years old
• Now :
Case 1Case 1
Year 2007
LEGION(Cement Simplex Antibiotic)
Year 2007
LEGION(Cement Simplex Antibiotic)
• Femoral implants:
Legion Oxinium size 4Stem 18 mm x 120 mmL-wedge 10 mm dist(x2) 10 mm post
• Patellar implant:
26 mm biconvex
• Femoral implants:
Legion Oxinium size 4Stem 18 mm x 120 mmL-wedge 10 mm dist(x2) 10 mm post
• Patellar implant:
26 mm biconvex
• Technical data• Technical data
• Tibial implants:
Legion baseplate size 36 mm offset couplerStem 22 mm x 120 mm
21 mm posterior stabilized articular insert
• Tibial implants:
Legion baseplate size 36 mm offset couplerStem 22 mm x 120 mm
21 mm posterior stabilized articular insert
Case 1Case 1
C. Simone C. Simone
C. Simone C. Simone
• Woman - 71 years old
• Post operative incident :
• Woman - 71 years old
• Post operative incident :
Case 1Case 1
Year 20071 week post-opLEGION
Fracture underthe TKA
Year 20071 week post-opLEGION
Fracture underthe TKA
Case 2Case 2
1975
Maquet
1975
Maquet
H. Lucienne H. Lucienne
• Woman - 73 years old
• Surgical past :
• Woman - 73 years old
• Surgical past :
Case 2Case 2
1979
Tibial Osteotomy
1979
Tibial Osteotomy
H. Lucienne H. Lucienne
• Woman - 73 years old
• Surgical past :
• Woman - 73 years old
• Surgical past :
Case 2Case 2
1987
Emslie
1987
Emslie
H. Lucienne H. Lucienne
• Woman - 73 years old
• Surgical past :
• Woman - 73 years old
• Surgical past :
Case 2Case 2
1990
Pseudarthosys of TTO
1990
Pseudarthosys of TTO
H. Lucienne H. Lucienne
• Woman - 73 years old
• Surgical past :
• Woman - 73 years old
• Surgical past :
Case 2Case 2
1992
Arthroscopy
1992
Arthroscopy
H. Lucienne H. Lucienne
• Woman - 73 years old
• Surgical past :
• Woman - 73 years old
• Surgical past :
Case 2Case 2
1993 Total Knee Arthroplasty
(Freeman - cemented femoral implant - uncemented tibial implant)
1993 Total Knee Arthroplasty
(Freeman - cemented femoral implant - uncemented tibial implant)
H. Lucienne H. Lucienne
• Woman - 73 years old
• Surgical past :
• Woman - 73 years old
• Surgical past :
Case 2Case 2
1994
TKA Revision
(Patella pain - femoral implant)
1994
TKA Revision
(Patella pain - femoral implant)
H. Lucienne H. Lucienne
• Woman - 73 years old
• Surgical past :
• Woman - 73 years old
• Surgical past :
Case 2Case 2
RecurvatumPainTibial osteolysis
RecurvatumPainTibial osteolysis
H. Lucienne H. Lucienne
• Woman - 73 years old
• Before our operation :
• Woman - 73 years old
• Before our operation :
Case 2Case 2
2007
TKA RevisionLegion - Offset
2007
TKA RevisionLegion - Offset
H. Lucienne H. Lucienne
• Woman - 73 years old
• Now :
• Woman - 73 years old
• Now :
• Femoral implants:
Legion Oxinium size 46 mm offset coupler Stem 15 mm x 160 mmL-wedge 15 dis x 5 posWedge 5 mm
• Patellar implant:29 mm biconvex
• Femoral implants:
Legion Oxinium size 46 mm offset coupler Stem 15 mm x 160 mmL-wedge 15 dis x 5 posWedge 5 mm
• Patellar implant:29 mm biconvex
• Technical data• Technical data
• Tibial implants:
Legion baseplate size 36 mm offset couplerStem 15 mm x 220 mm
15 mm posterior stabilized articular insert
• Tibial implants:
Legion baseplate size 36 mm offset couplerStem 15 mm x 220 mm
15 mm posterior stabilized articular insert
Case 2Case 2
H. LucienneH. Lucienne
Case 3Case 3
1991 Arthroscopy
1991 Arthroscopy
H. Albert H. Albert
• Man - 71 years old
• Surgical past :
• Man - 71 years old
• Surgical past :
Case 3Case 3
2002 Quadriceps tendon pulling up
2002 Quadriceps tendon pulling up
H. Albert H. Albert
• Man - 71 years old
• Surgical past :
• Man - 71 years old
• Surgical past :
Case 3Case 3
H. Albert H. Albert
• Man - 71 years old
• Surgical past :
• Man - 71 years old
• Surgical past :
2006 Total Knee Arthroplasty
(Tibial osteolysis, medial rotation, patellar sub-dislocation)
2006 Total Knee Arthroplasty
(Tibial osteolysis, medial rotation, patellar sub-dislocation)
Case 3Case 3
2007 TKA Revision
Legion
2007 TKA Revision
Legion
H. Albert H. Albert
• Man - 71 years old
• Now :
• Man - 71 years old
• Now :
• Femoral implants:
Legion Oxinium size 7Stem 18 mm x 160 mmL-wedge 10 dis x 5 posL-wedge 5 dis x 5 pos
• Patellar implant:
29 mm biconvex
• Femoral implants:
Legion Oxinium size 7Stem 18 mm x 160 mmL-wedge 10 dis x 5 posL-wedge 5 dis x 5 pos
• Patellar implant:
29 mm biconvex
• Technical data• Technical data
• Tibial implants:
Legion baseplate size 7Stem 16 mm x 160 mm
13 mm posterior stabilized articular insert
• Tibial implants:
Legion baseplate size 7Stem 16 mm x 160 mm
13 mm posterior stabilized articular insert
Case 3Case 3
H. AlbertH. Albert
For the tibial insert:
This revision system is based on an intramedullary guide.
Post scriptum : the anatomic axis approached the mechanicalaxis to within 1° on averagein both the anteroposterior and lateral planes.
For the tibial insert:
This revision system is based on an intramedullary guide.
Post scriptum : the anatomic axis approached the mechanicalaxis to within 1° on averagein both the anteroposterior and lateral planes.
Conclusion Conclusion
LEGIONRevision Knee System
LEGIONRevision Knee System
Bono JV, Roger DJ, Laskin RS, Peterson MGE,Paulsen CA. Tibial intramedullary alignment in total knee arthroplasty. 1998;13(2):241.
Bono JV, Roger DJ, Laskin RS, Peterson MGE,Paulsen CA. Tibial intramedullary alignment in total knee arthroplasty. 1998;13(2):241.
Thomas K. Fehring. Use of Stems in Revision Total Knee Arthroplasty. Revision Total Knee Arthroplasty. James V. Bono. Richard D. Scott Editors. 2005;13:137-144Thomas K. Fehring. Use of Stems in Revision Total Knee Arthroplasty. Revision Total Knee Arthroplasty. James V. Bono. Richard D. Scott Editors. 2005;13:137-144
It’s not like other revision knee systems where the direction of the tibial base plate restricted by the bone defects (+ grafts) determines the axis of the stem.
In such case, the use of long implants transfers stress from the deficient plateau to the shaft and might cause significant periarticular stress shielding.
It’s not like other revision knee systems where the direction of the tibial base plate restricted by the bone defects (+ grafts) determines the axis of the stem.
In such case, the use of long implants transfers stress from the deficient plateau to the shaft and might cause significant periarticular stress shielding.
Conclusion Conclusion
LEGIONRevision Knee System
LEGIONRevision Knee System
Diaphyseal engaging stemcausing malalignment ina tibia with valgus bowing.
Diaphyseal engaging stemcausing malalignment ina tibia with valgus bowing.
With the LEGION Revision Knee System,it’s necessary to have optimal length and width of stem to obtain a stable primary fixation.
To restore the anatomical axis of the tibial plateau; offset couplers, hemi-angled, hemi-stepped, full-angled or full-step wedges are available.
With the LEGION Revision Knee System,it’s necessary to have optimal length and width of stem to obtain a stable primary fixation.
To restore the anatomical axis of the tibial plateau; offset couplers, hemi-angled, hemi-stepped, full-angled or full-step wedges are available.
Conclusion Conclusion
LEGIONRevision Knee System
LEGIONRevision Knee System
This complex LEGION Revision Knee System allows the re-establishment of a balanced biomechanical knee arthroplasty and a favourable distribution of the stress shielding on the bone.
This complex LEGION Revision Knee System allows the re-establishment of a balanced biomechanical knee arthroplasty and a favourable distribution of the stress shielding on the bone.
Conclusion Conclusion
LEGIONRevision Knee System
LEGIONRevision Knee System
In practice :
Use preferably long stem
thansmall and large stem
to have a gooddistribution of loads
In practice :
Use preferably long stem
thansmall and large stem
to have a gooddistribution of loads
Conclusion Conclusion
LEGIONRevision Knee System
LEGIONRevision Knee System
• In case of :
press-fit stem and osteoporosys ofsmall bone cortical
take an implant 1 mm narrower than the last reamer size to avoid excessive constraints on bone structures.
• In case of :
press-fit stem and osteoporosys ofsmall bone cortical
take an implant 1 mm narrower than the last reamer size to avoid excessive constraints on bone structures.
Conclusion Conclusion
Reamer sizeReamer size
-1 mm-1 mm
14mm13mm11mm14mm
LEGIONRevision Knee System
LEGIONRevision Knee System
• When you have assembled the tibial base trial, the offset coupler and the stem,NEVER USE AHAMMER with thetibial baseplate impactorto insert the trial into the tibia.
• When you have assembled the tibial base trial, the offset coupler and the stem,NEVER USE AHAMMER with thetibial baseplate impactorto insert the trial into the tibia.
Conclusion Conclusion
XX
LEGIONRevision Knee System
LEGIONRevision Knee System
• USE the LONG STEM EXTRACTOR TOOL
and THE UNIVERSAL EXTRACTORto avoid compressing the trial J-hook system
and assess wrongly the correct length of the stem.
• USE the LONG STEM EXTRACTOR TOOL
and THE UNIVERSAL EXTRACTORto avoid compressing the trial J-hook system
and assess wrongly the correct length of the stem.
Conclusion Conclusion
LEGIONRevision Knee System
LEGIONRevision Knee System
• All these conclusions are particularly valid in case of :
- old patient- obesity
- osteoporosys- large bone defect
- tibial implant
• All these conclusions are particularly valid in case of :
- old patient- obesity
- osteoporosys- large bone defect
- tibial implant
Conclusion Conclusion
LEGIONRevision Knee System
LEGIONRevision Knee System
Thank You for your attentionThank You for your attention
LEGIONRevision Knee System
LEGIONRevision Knee System
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