Operative Procedure

Surgical Technique of Total Knee Replacement

Painting & Drapping

Limb/limbs to be operated are locally prepared by hair clipper and then scrubbed with the betadine solution 10% and benzhexadine solution from groin to toes. Once the limbs are dried they are sealed with surgical iodrapes. Disposable drapping sheets are used to isolate and cover the limbs. Depending on the systolic blood pressure tourniquet pressure is set and tourniquet is inflated with the knee in elevated and fully flexed position.

Midline skin Incision

A midline vertical skin incision is made extending proximally ( from top) just above the joint capsule and extending distally (downwards) along the medial 1/3 of patella and extending downwards and ending medial and 1 cm distal to the tibial tuberosity. Superficial bleeders are coagulated. The dissection is carried further deep to expose the quadriceps tendon proximally and the patellar tendon distally.

Medial-para patellar approach

The deep surgical dissection is done by excising the quadriceps tendon just lateral to the insertion of vastus medialis leaving approximately 1cm of quadriceps tendon cuff attached to vastus medialis. The dissection is carried distally along the medial border of the patella excising the medial retinaculum. Further distally it ends 1 cm medial to the tibial tuberosity excising the proximal tebial periosteum.

Patella displaced laterally

With the help of cautery lateral retinaculum is incised to release lateral retinaculum adjoining lateral border of patella. This helps in lateral displacement of patella.

Retro patellar fat pad exision

Once the patella is laterally displaced retro patellar fat pad becomes fully visible. One third of this is then excised to prevent its impingement in the implant.

Extra medullary tibial alignment

After adequate soft tissue release tibia is subluxed anteriorly. Extra medullary tibial alignment rod is fixed using second ray of foot as distal landmark and tibial tuberosity as proximal landmark.

Proximal tibial cut

Depressed medial condyle is used as the proximal landmark for making the proximal tibial cut.

Intramedullary Fermoral alignment

The femoral notch is drilled and intramedullary rod is inserted and alignment is fixed in 3 degrees external rotation.

Distal femoral cut

The distal femoral cutting jig is applied on the intramedullary rod and rod is removed followed by distal femoral cut.

Femoral sizer

The Femoral sizing jig is used to measure exact femoral size required.

Anterior Cut / Posterior Cut/Chamfer Cut

The femoral cutting jig is applied which is used for making anterior,posterior and chamfer cuts.

Patellar tracking

After the corresponding femoral and tibial trails are applied, patellar traking is checked.

Hemostasis

After final implantation thorough lavage is done and tourniquet is released and hemostasis is achieved then the surgical site is closed back in layers.

Final outcome

5 to 7 degrees of valgus is achieved with full correction of deformaties like ffd and varus.

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