| Thank you for the comments Femoral
Osteotomy. We did discuss doing this during the case. It would have increased the
complexity of the operation the length and blood loss and the risks of failure. The time
to have done this would have been at the original injury when it was clear that you were
going to salvage the knee. If an osteotomy was essential I think it might be done as a
separate operation 6 months ahead.
Valgus angulation: I haven't measured on the Xray but the angulation cannot be much
more than 6 degrees which is the set angulation determined by the distal cut. If it is
more than that, it is likely because of the stem tilting the articular component as we
were cementing. It looks more dramatic because of the lateral offset. You don't see the
alignment of the component "straightening out" again behind the anterior
articular surface, but if you look carefully the sides of the femoral condyles are
not parellel to the stem just above the articular surfaces.
Custom component: I think this might have been a good idea.
I thought that the reconstructions from the CT scans would not be good enough to allow us
to take the measurements needed for creating a custom component but they probably were OK.
Long Stemmed tibial component. This was selected pre-op
because I thought we would need a constrained coupling. When it became clear that we could
have a stable situation with a posterior stabilized tibial surface I did discuss using a
standard stemmed tibial component. I think the decision was made partly from inertia and
partly from the feeling that if he did require a constrained coupling in the future we
might just have to change the tibial surface. What do you consider to be the significant
problem with the long stem? Hard to revise?
Dr Klueber wrote "semiconstrained knees will work well
just a few months, then instability occurs." (unless the ligaments are intact) Do you
consider the Posterior Stabilized type of knee replacement to be
"semiconstrained" because we are doing these increasingly commonly? Is the
comment based on a published study?
Dave Hubbard asked about re-infusion drain. We don't have
such a thing in our hospital and have put it on our wish list.
I didn't understand Rene's question about beer ;-) I relax
after difficult cases by writing webpages of course!!
Might I suggest that any further discussion take place on
the arthroplasty list to limit crossposting. I will likely post a further follow-up and
summary of the discussion to the orthopod list later.
Myles Clough mylesclough@shaw.ca
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