OrthopaedicPrinciples.com

Integrating Principles and Evidence

Integrating Principles and Evidence

-Knee Arthroplasty

Functional Alignment : Knee Arthroplasty

Courtesy: Dr. Jon Conroy, Dr Ashok Shyam, Ortho TV Functional Alignment in Robotic Total Knee Arthroplasty: Principles, CPAK Phenotyping, and Case Execution Rationale for Functional Alignment (FA) Clinical Driver: Traditional mechanical alignment frequently requires extensive soft-tissue stripping to force native anatomical variations into a rigid, non-anatomical rectangular gap. Core Philosophy of Functional Alignment: Uses either […]

Mechanical Alignment Principle in TKA

Courtesy: Dr Ashok Rajgopal, Dr Ashok Shyam, Ortho TV Total Knee Arthroplasty Alignment Philosophies: The Critical Evidence-Based Perspective The Driver Behind Alternate Alignments: Patient Dissatisfaction The Core Argument: Contemporary proponents of alternate alignments argue that traditional techniques leave up to 15% to 20% of total knee arthroplasty (TKA) patients dissatisfied with their joint function. The […]

Restricted Kinematic Alignment in TKR

Courtesy: Dr Makridis Konstantinos, Dr Ashok Shyam, Ortho TV Robotic-Assisted Total Knee Arthroplasty: Kinematic and Restricted Kinematic Alignment (rKA) Fundamental Biomechanics of Knee Kinematics Primary Cylindrical Flexion Axis: The transverse axis of the distal and posterior femoral condyles guides the flexion-extension arc. Asymmetric Native Rollback: During deep flexion, the medial femoral condyle exhibits minimal anteroposterior […]

Kinematic Alignment Pros and Cons

Courtesy: Dr Krishna Kiran, Dr Ashok Shyam, Ortho TV Knee Kinematics and Total Knee Arthroplasty Alignment Philosophies Native Knee Kinematic Anatomy Asymmetric Joint Morphology: Medial and lateral femoral condyles and tibial plateaus are asymmetric. Meniscal Constraints: The medial meniscus is firmly anchored to the deep medial collateral ligament (MCL). The lateral meniscus is mobile, sliding […]

Two Stage Revision, the Gold Standard for Infected TKR

Courtesy: Dr Hemant Wakankar, Dr Ashok Shyam, Ortho TV Two-Stage Revision for Periprosthetic Joint Infection (PJI) Core Concept & Rationale Primary Concern: Recurrent infection remains the main driver for choosing two-stage revision. Gold Standard: Two-stage exchange arthroplasty remains the benchmark for chronic PJI eradication. Microbiological Prerequisite: Discontinue all systemic antibiotics for at least 2 weeks […]

Newer Enabling Technology in TKR

Courtesy: Dr Bill Walter, Dr Ashok Shyam, Ortho TV Enabling Technologies in Joint Arthroplasty: Robotics, Navigation, and Health Systems Panel Landscape and Current Practice Patterns Preoperative Imaging Protocols: Routine mechanical workups utilize full-length standing scanograms or long-leg films alongside orthogonal knee series. Image-based systems mandate thin-slice CT scans for virtual 3D surface mapping. Imageless platforms […]

Mega Prosthesis in Revision TKA –Tips, Tricks & Durable Fixation

Courtesy: Dr Rajeev Kumar Sharma, Dr Ashok Shyam, Ortho TV Megaprosthesis Reconstruction: Indications, Complications, and Technical Pearls Indications for Megaprosthetic Reconstruction Extensive Segmental Bone Loss: Massive osseous defects encountered during complex revision arthroplasty where standard stems and modular augments cannot bridge the gap. Extraction-Related Bone Loss: Iatrogenic destruction and severe cortical deficiency occurring during the […]

Femoral Revision – Monobloc & Modular Stems in TKR

Courtesy: Dr Vijay Bose, Dr Ashok Shyam, Ortho TV Revision Total Hip Arthroplasty: Monoblock vs. Modular Tapered Fluted Stems Historical Perspective & The Transatlantic Divide The American Philosophy (1980s–1990s): Popularized by Charles Engh and William Harris Jr., advocating extensively porous-coated cylindrical cobalt-chromium stems (e.g., AML). The European Philosophy: Heinz Wagner introduced the Wagner stem in […]

Intra Op and Post Op Cocktail in TKR

Dr David Mayman, Dr Ashok Shyam, Ortho TV Perioperative and Intraoperative Pain Management in Total Knee Arthroplasty Anesthesia Modalities: Neuraxial Dominance Nearly 100% of patients receive neuraxial anesthesia (spinal or epidural) unless clear medical contraindications exist. Contraindications: Extensive lumbar spine instrumented fusion, severe uncorrected coagulopathy, or pulmonary hypertension (which may necessitate controlled general anesthesia). Clinical […]

Indications and ContraIndications of Unicompartmental Knee Replacement

Courtesy: Mr Fahad Hossain, Walsall NHS Healthcare, UK Overview Both unicompartmental knee arthroplasty and high tibial osteotomy preserve bone stock and native soft tissues when compared to total knee arthroplasty. Both procedures provide more physiological knee kinematics and improved native proprioception relative to total knee arthroplasty. General Indications High Tibial Osteotomy Preferred in patients younger […]