Courtesy: Dr T Vail, Ashok Shyam TV, Ortho Overview TKA is successful in ~95% of patients. The remaining 2–5%: Experience pain, stiffness, or dissatisfaction. Often consume a disproportionate amount of clinical time. Typical scenario: Radiographs appear normal. Patient reports the knee “just doesn’t feel right.” Clinical Presentation Patients may report: Stiffness Swelling Limited flexion […]
Mobile Bearing TKR
Courtesy: Dr Maniar, Ashok Shyam TV, Ortho Why Consider a Mobile-Bearing Knee? Primary concern: Polyethylene wear: At the articular surface At the undersurface (backside wear) Fixed-bearing knees have demonstrated: Significant articular wear. Undersurface micromotion leading to wear debris. Associated osteolysis and revision in mid-term follow-up. Problem 1: Articular Surface Wear Contact Stress Principle Contact stress […]
Cruciate Retaining TKR
Courtesy: Dr A Reddy, Ashok Shyam TV, Ortho Introduction Focus: Cruciate-retaining (CR) total knee arthroplasty. Personal practice preference: ~99% of primary TKAs performed as CR knees. Used even in severe deformities. Transition from posterior-stabilized (PS) to CR: Smaller knee sizes. Thinner femoral condyles. Concerns regarding box cuts in smaller bone stock. Why Choose Cruciate Retaining? […]
Early TKR Failure-Common Mistake
Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho Foundational Premise We can always improve surgical outcomes. Most complications occur because of preventable errors. Understanding common technical mistakes helps reduce failures. Common Causes of Surgical Errors 1. Poor Exposure Limited visualization leads to “guesswork.” Small-incision approaches may: Compromise rotational alignment. Leave retained cement (especially posterolateral corner). […]
Arthrofibrosis
Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho Introduction Arthrofibrosis is an uncommon but frustrating complication after total knee arthroplasty (TKA). Incidence: < 2% following primary TKA. Defined as: Functional impairment with restricted knee motion. Important distinction: Not all stiff knees are arthrofibrotic. Definition of a Stiff Knee Knee flexion < 75° generally considered stiff. […]
Advances & Techniques in Joint Replacement Surgery
Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho Case 1: Young, Active Patient with Varus & Flexion Deformity Patient Profile Age: 56 years Weight: 250 lbs Long-standing post-traumatic deformity 15° varus + 15° flexion contracture Previously active tennis player Key Considerations Young, high-demand patient. Long life expectancy ? risk of polyethylene wear. Need durable fixation. […]
Radiographic Criteria for Optimum TKR
Courtesy: Dr S Macdonald, Ashok Shyam TV, Ortho Don’t Forget Pre-Operative Evaluation Before analyzing a painful postoperative knee, always revisit: Was TKA truly indicated? Was there clear bone-on-bone osteoarthritis? Could pain have originated elsewhere (e.g., hip)? Key Clinical Lesson Mild radiographic knee arthritis + severe hip arthritis ? knee replacement will not solve the pain. […]
Prevention of Infection in TKR
Courtesy: Dr S Macdonald, Ashok Shyam TV, Ortho Why This Matters Incidence of infection after TKA: ~1% to 2.5%. Devastating complication: Severe patient morbidity. Surgeon burden. High healthcare cost. Prevention requires a multifactorial strategy: Patient factors Intraoperative factors Postoperative factors 1 Patient-Related Risk Factors Some modifiable, some not. Gender Large registry data (e.g., Finnish arthroplasty […]
Correction of Flexion Contracture in TKR
Courtesy: Dr S Macdonald, Ashok Shyam, Ortho TV Flexion contracture is frequently encountered in advanced osteoarthritis—particularly in populations presenting late. It significantly affects gait mechanics and functional recovery. Why It Matters Flexion contracture increases quadriceps workload. Bilateral 30° contractures ? ~50% increase in quadriceps effort. Leads to: Energy-inefficient gait Reduced walking endurance Poor postoperative satisfaction […]
Knee Extra Articular Deformity Correction
Courtesy: Dr S Macdonald, Ashok Shyam TV, Ortho Significant extra-articular deformities are relatively uncommon in many Western practices but may be more frequently encountered in post-traumatic populations. Common causes include: Malunited fractures Prior osteotomies Metabolic bone disease (e.g., Paget’s disease) The challenge is achieving proper limb alignment without compromising ligament stability. Three Treatment Options When […]
Osteotomy for Complex Knee Pathology
Courtesy: Dr Alan Getgood, Ashok Shyam, Ortho TV Introduction The session focuses on practical concepts in knee osteotomy, using real clinical cases to illustrate decision-making. Osteotomy remains an important procedure for young, active patients with malalignment and compartmental knee pathology. Revisiting fundamental principles is valuable because: These procedures can be technically demanding. Proper patient selection […]
Knee-Patient Specific Alignment
Courtesy: Dr Brett A Fritsch, Ashok Shyam, Ortho TV Personalized Alignment in Total Knee Arthroplasty Introduction A fundamental concept in knee surgery is that no two knees are identical. Each patient demonstrates unique variations in: Bone morphology Limb alignment Soft tissue balance Historically, surgeons often treated osteoarthritic knees with a uniform surgical approach, assuming similar […]
Functional Alignment of Knee
Courtesy: Dr Eugene E K, Ashok Shyam, Ortho TV Functional Alignment in Knee Replacement Surgery Introduction Alignment strategies in total knee replacement have evolved significantly over the years. Many surgeons initially adopted mechanical alignment, which has been the traditional and widely practiced method for several decades. Over time, alternative approaches such as kinematic alignment and […]
MCL Injury Treatment
Courtesy: Dr Andy Williams, Ashok Shyam, Ortho TV Understanding the Medial Collateral Ligament in Knee Stability Introduction Research over recent years has focused on improving the understanding of the medial collateral ligament of the knee. The goal has been to study three key aspects: Detailed anatomy Biomechanics Surgical techniques for injury management These studies have […]
ACL Tears in adolescents
Courtesy: Maria Tuca, Ashok Shyam, Ortho TV Anterior Cruciate Ligament Injuries in Adolescents: Key Principles of Management Introduction Injuries of the anterior cruciate ligament in adolescents are increasingly common. These injuries should not be managed using the same strategies applied to adults. Adolescents represent a unique patient group due to: Open growth plates High activity […]