Download - Algorithm to correct Varus Knee in a TKR
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The VARUS KNEEDr Vaibhav Bagaria
Sir HN Reliance Foundation HospMumbai India
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Surgical AnatomyPes Anserinus
Superficial MCL
Deep MCL
Joint Capsule
Semi Membranous
Posterior Oblique ligament
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MCL
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Goal - Symmetrical Gaps
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What is a Varus Knee
Maquet’s Line- Load Bearing Axis, Passes from centre of femoral head to Centre of Talus.
Ideally through the centre of Knee
Medial to Centre in case of Varus deformity
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Maquet's Line
Maquet’s Line- Load Bearing Axis, Passes from centre of femoral head to Centre of Talus
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Classification
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Case1
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Case 2
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Case 3
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Case 4
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Case 5
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Medial Exposure Using Scalpel -Subperisoteal elevation of the medial sleeve
Includes Joint Capsule and deep MCL
Continue with perisoteal elevator to elevate till Meta-physeal flare of tibia.
RanSall Manouveur: flexion- ER @ tibia
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Medial Sleeve Creation
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Step 1: Osteophytes
Remove all osteophytes from Femur & Tibia as they can tent the medial soft tissue sleeve and consequently shorten the MCL.
Remember to check the Posterior femoral condyle and Posteromedial tibia -> as they tighten extension gap.
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Osteophyte Removal
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Step 2: PCLMake sure PCL is resected before balancing
PCL is 2ry medial stabiliser so care should be taken not to release the entire sleeve of the tibia because it may cause medial instability
In CR PCL is left intact
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PCL Release
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Cuts and Balancing
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Step 3: Semi Membranosus
If the tightness remains medially, the semimembranosus and posteromedial capsule can be released off the proximal tibia.
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Semi Membranosus release
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Step 4 - Posterior Oblique Lig
If the gap is tight only medially in the extension during varus valgus stress -> posterior Oblique Ligament can be subperiosteally released.
Is best done in a figure of 4 position
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Step 5: Superficial MCL
Assess the flexion extension gap using Lamina Spreader/ Trial Component/ Spacer block - Varus Valgus.
If tight in both - release sub-periosteally SMCL off proximal tibia but not completely of distal tibia
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Superficial MCL Release
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Pie Crusting
AF PE ( Atrial fibrillation - Pulmonary Embolism)
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Structures Responsible
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step 6 Pes Release
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Step 7: Shift and ResectInitial conservative tibial resection
Based on lateral side: 10mm
Angle perpendicular to long axis with 3 - 5 slope
Measure for size of tray
Downsize and lateralise
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Shift & Resect
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Shift & Resect
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Shift & Resect
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Lateralizing the component
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Residual LCL laxity
IT band can usually dynamically restore the stability in most cases.
1st options: increase medial release/ medial cut and use thicker Poly
2nd: LCL advancement
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AlgorithmCreate a Medial Subperiosteal Sleeve with DMCL
Remove the osteophytes
Take the cuts -remember ER may need to be increased
Check the Gaps
Release Semimembranosus, POL
SMCL ant or Post
Shift and Resect
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