tka navigation for severe deformations pascal a. vendittoli, md msc frsc montréal, canada
TRANSCRIPT
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TKA Navigation for severe deformations
Pascal A. Vendittoli, MD MSc FRSC
Montréal, Canada
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How good are we
without surgical
navigation ?
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0
5
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Valgus VarusMechanical axis
0° 2° 4° 6° 8°2°4°6°8°
%
NavigatedControls
Navigation reduces outliers
Jenny, ESSKA 2002
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Pourquoi la navigation?
Radiographie simple2 plans: frontal et sagital
Ombre de la réalité…
angulation et translation
rotation?
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FemurDeformation
exceed instrument with preset
angle(7°: Varus - 4°: Valgus)
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Deformed or obliterated intra medullary canal
Extra medullary alignment + fluoroscopy
Lateral alignment almost impossible…
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Extra-medullary instrument
Translation
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Is there a tool available to help us?Yes : computer assisted surgery
Can Navigation Do Everything?
NO…
• Planification is still the key for success
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Grandeur + Niveau de la déformation
Donc il n’existe pas d’indication absolueAssociation de l’angle + le niveau = l’indication
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Example: 20 degree valgus deformity
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Intra articular correction vs
summit of the deformity?
Not decided on #degrees….
• Collateral ligaments attachment
• Joint line obliquity
• Age and possible use of TS implant
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Limiting Factor: Coll Ligaments
25-30 mm
222-28 mm
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Maximum 7-10 mm
If more:3 options
-corrective osteotomy-epicondyle transfert -constrained implant
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When your plan is made, use thePower of Computer Assisted Surgery
• Follow intra operatively your pre op planning
• Make small adjustments according to intra op findings
• Feel confident that what you expect is what you will get…
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25 degresComplete correction:
OversizeorFlexion instability
No correction=Post Impingement
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10 degres flexionAnterior appositionTo maintain post space
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Sagital 15 degres
flexion of the implant=undersize
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5 degres extension of the implant
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Young patient 45 y Full medial release = still unbalancedKept 3 degres varusto avoid constrained implant
Sagital plan =4 degres of extension
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Discussion
• I do use navigation for all my primary TKA: ASM
• I only use full navigation for deformed cases
Advantages:— Be familiar with the unusual anatomy— Intra operative fine tunning…— Avoiding difficult hardware removal— Full extention ?
— Increased time (20 minutes) is compensated in the deformed cases (fluoroscopy, time spent for adjustment, etc.)
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RotationFémur
Col fémoralCondyles post.
14° ext.
Tibia
Plateaux postérieurs
Malléoles 26 ° ext.
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Sites contributoires Sommetde la
déformation
CortexAxes mécaniques
Axes anatomiques
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Niveau de la déformation
• Proche du genou : malalignement• Loin du genou : malorientation