TKA
Positioning – answer Pt. is placed supine on the table with the operative limb in the
knee holder and tourniquet on upper thigh
Approach - answera medial Para patellar approach to expose knee. Evert the patella to
reveal tibia and femur, and flex the knee to begin preparing the femur
Femoral Prep - answerIM Drill along the anatomical axis of the femur into the
intramedullary canal until flush.
Distal Femoral Cut - answerInsert the Distal Femoral Resection Guide (with fluted rod)
into the IM canal; perpendicular to the mechanical axis. The fluted rod will release
pressure. Pin the resection guide into place on the femur; remove the outrigger and
leave the distal femoral resection guide behind. Using a bone saw, perform the distal
femoral resection (approx. 10mm). Remove pins with pin puller and cutting box.
Femoral Sizing - answerPlace the AP sizing guide along the posterior condyles of the
femur. The AP sizing guide will assess ~3° external rotation and femoral component
size via stylus. Once size is determined drill pin holes and remove guide.
Femoral Cuts - answerPosition appropriate size 4-in-1 Cutting Block on the distal
femoral cut via the drill holes provided by the AP sizing guide. The cutting block is
checked by the Angel Wing to avoid 'notching' of the anterior cortex. The following cuts
are made chronologically anterior cut, posterior, posterior chamfer, and anterior
chamfer.
Place the femoral trial component on the prepared distal femur with the femoral
impactor and mallet
Tibial Prep - answerA PCL retractor will expose the tibia for preparation. Soft tissue
release; rid of the meniscus and sacrifice the ACL.
Place the Extramedullary Tibial cutting guide around the ankle; align the long axis of the
tibia with the second toe. The extramedullar tibial cutting guide will determine: a
varus/valgus adjustment, tibial posterior slope of the cut, and check depth of the cut via
a stylus. Once in position, pin into place and begin tibial resectioning via bone saw and
osteotome (being more cautious the more posterior you get).
Tibial Sizing - answerUse Tibia Base Plate Trials to determine tibia size; must cover
80% of the tibial plateau cortical rim to avoid subsiding.
Positioning – answer Pt. is placed supine on the table with the operative limb in the
knee holder and tourniquet on upper thigh
Approach - answera medial Para patellar approach to expose knee. Evert the patella to
reveal tibia and femur, and flex the knee to begin preparing the femur
Femoral Prep - answerIM Drill along the anatomical axis of the femur into the
intramedullary canal until flush.
Distal Femoral Cut - answerInsert the Distal Femoral Resection Guide (with fluted rod)
into the IM canal; perpendicular to the mechanical axis. The fluted rod will release
pressure. Pin the resection guide into place on the femur; remove the outrigger and
leave the distal femoral resection guide behind. Using a bone saw, perform the distal
femoral resection (approx. 10mm). Remove pins with pin puller and cutting box.
Femoral Sizing - answerPlace the AP sizing guide along the posterior condyles of the
femur. The AP sizing guide will assess ~3° external rotation and femoral component
size via stylus. Once size is determined drill pin holes and remove guide.
Femoral Cuts - answerPosition appropriate size 4-in-1 Cutting Block on the distal
femoral cut via the drill holes provided by the AP sizing guide. The cutting block is
checked by the Angel Wing to avoid 'notching' of the anterior cortex. The following cuts
are made chronologically anterior cut, posterior, posterior chamfer, and anterior
chamfer.
Place the femoral trial component on the prepared distal femur with the femoral
impactor and mallet
Tibial Prep - answerA PCL retractor will expose the tibia for preparation. Soft tissue
release; rid of the meniscus and sacrifice the ACL.
Place the Extramedullary Tibial cutting guide around the ankle; align the long axis of the
tibia with the second toe. The extramedullar tibial cutting guide will determine: a
varus/valgus adjustment, tibial posterior slope of the cut, and check depth of the cut via
a stylus. Once in position, pin into place and begin tibial resectioning via bone saw and
osteotome (being more cautious the more posterior you get).
Tibial Sizing - answerUse Tibia Base Plate Trials to determine tibia size; must cover
80% of the tibial plateau cortical rim to avoid subsiding.
