PLANNING & TEMPLATE

VAIBHAV BAGARIAJoint Replacement Surgeon

Sir HN Reliance Foundation HospitalGirgaum, Mumbai

GOALS

• Well Aligned

• Well Balanced

• Linear Patellar Tracking

• Infection free healing

EXPECTATIONS

• REDUCE PAIN

• IMPROVE FUNCTION

• IMPROVE QUALITY OF LIFE

PREOPERATIVE WORKUP

• PATIENT SELECTION

• PREOP MEDICAL ASSESMENT

• CLINICAL EXAM

• RADIO EXAM

• IMPLANT SELECTION

• COUNSELLING AND CONSENTING

TECHNICAL GOALS

• RESTORATION OF THE NEUTRAL MECHANICAL ALIGNMENT

• PRESERVATION ( RESTORATION) OF JOINT LINE

• PERIARTICULAR LIGAMENT BALANCING

• MAINTAING LINEAR PATELLAR TRACKING AND Q ANGLE

IMAGING

• STANDARD AP/ LAT/ SKYLINE VIEWS

• SCANNOGRAM - PREFERABLE BUT NOT MANDATORY

SCANNOGRAM

• EXTREMES OF HEIGHT

• ALTERED HIP/FEMORAL NECK ANATOMY: DYSPLASIA, TRAUMA, INFECTION, PREVIOUS OPERATION

• OBVIOUS CLINICAL DEFORMITY OF TIBIA AND FEMORAL SHAFTS

SUPPLEMENTARY IMAGING

• TUNNEL VIEW: POSTERIOR WB SURFACE, OCD, LOOSE BODIES

• CT/MRI: COMPLEX PRIMARY FOLLOWING TRAUMA, DYSPLASIA, ALTERED BONE STOCK OR PATIENT SPECIFIC INSTRUMENTATION

What to see?

• Determine the femoral & tibial cuts and cut angles

• Position of the femoral canal entry point

• Anticipating the ligament release

• Identifying the bone defects, joint subluxation or lig laxity

• Tempting prosthetic components

AP View

• Joint Compartments affected & Deformity

• Osteophytes: Imp for releases

• Evidence of previous surgery

• Alignment & Templating

Lateral view

• Flexion deformity

• Osteophytes

• Alignment

• Subchondral sclerosis

• Vessels

On femur: FAA, FMA, VCA

• Femoral Anatomical axis: Line that bisects the Intramedulary canal

• Exit point determines the entry point of IM jig

• Draw Valgus Cut Angle: 5 - 7 degree decreasing with patient height.

• VCA is perpendicular to femoral mechanical axis ( FMA)

Tibia

• Anatomic axis corresponds to Mechanical Axis

• IM or EM Jigs Used

• The cut is perpendicular to both

• If deformity MA is to be considered

Tibial Axis

QUIZ TIME

Take Home Message

• FAA

• TAA

• Valgus Cut

• Tibial Cut

• Osteophyte

• Implant Sizing & Positioning

Proper preoperative

planning prevents piss-

poor performance