10 COMMANDMENTS TO A STRAIGHT KNEE

Dr Vaibhav BagariaJoint Replacement Surgeon

Sir HN Reliance Foundation HospitalMumbai India

#1 Thou Shalt Do clinical assessment

Do not succumb to temptation of sloth, Laziness, or avoiding inconvenience by neglecting due diligence

Not to miss!

• Previous Scars

• Sagital & Coronal Plane deformity

• Stability

• PFJ

• Extensor Mech

• Hips/ Foot/ Spine

• Distal Pulses

#2 Know your Biomechanics

Sunny leone Pic of Arthroplasty

#3: Thou Shalt Do Preoperative planning

Plans Never Fail we fail to plan

Plan your Cuts

#4: Thou Shalt do adequate release

Remember Releases

#5: Thou shall take proper Tibial Cut

• Tibial Cut is perhaps the most important cut - your foundation cut

• Choose appropriate strategy: Intramedullary or Extramedullary

• Do not be dogmatic!!!

Tibial Cuts - IM or EM

#6: Thou Shalt choose femur cut strategy

• Conventional

• Navigation

• PSI

• I Assist

A word about Gadgets

Do not Miss out on a great Investment because of fees. Be willing to pay when expense add value

You Must strike a balance: Do not be a miser and dogmatic for technology And do not be wasteful by using gadgets unnecessary

without receiving a value added benefit.

Do not need car to go home, do you?

CAS great for EM deformity, Complex primaries & when you do not wish to cannulate

#7: Thou Shalt understand Ext Rotation Philosophy

• Epicondylar axis

• Posterior condylar referencing

• Whiteside line

• Parallel to Tibial Cut

ER Strategies

#8: Thou shalt prepare for special conditions

• Post traumatic

• Post HTO

• Pagets disease

• Large deformities

• Poor bone stock and bone loss

#9: Thou Shalt check check & recheck

Getting better at TKR is largely governed by good mathematics.

It is a science accomplished by artful work built around the core principle of mathematical expectation

Do not Gamble: Insurance companies do not gamble and neither do casino owners.. only their customers do! So should you??

So check, check recheck!!!

#10: Thou Shalt learn from your own mistake

The greatest obstacle to discovery is not ignorance - Its the illusion of Knowledge

- D J Boorstin

Invest in your self: Train, Learn, Grow!!!

10 Commandments of Straight TKR

• Clinical Assessment

• Understanding Biomechanics

• Preoperative planning & Tempting

• Releases

• Tibial Cut - Foundation

• Femur cut philosophy

• ER Set

• Check check Recheck

• learn from mistakes