PLANIFICACION PREOPERATORIA PROTESIS TOTAL

DE RODILLA

ELMER JESUS NARVAEZ RODRIGUEZ

MR2 TRAUMATOLOGIA Y ORTOPEDIA

HOSPITAL II CHOCOPE
 INDICACIONES
Artritis severa (RA, OA, etc.) que causa dolor
significativo, discapacidad y restriccin (gonartrosis
avanzada grado IIIIV)
Considerar la esperanza de vida y las expectativas de
los pacientes
Deformidad importante
Tricompartimental
Unicompartimental (afectacin unicompartimental
adultos y jvenes)

CAMPBELL-CIRUGIA ORTOPEDICA. S TERRY CANALE, JAMES H BEATY

OSTEOARTHRITIS
RHEUMATOID
ARTHRITIS
 CONTRAINDICACIONES:
Local or general sepsis
Neuropathic joints
Arthrodesed joints?
Poor skin coverage
Lack of muscle control
Inability to co-operate post operatively

CAMPBELL-CIRUGIA ORTOPEDICA. S TERRY CANALE, JAMES H BEATY

 Pre-Op Evaluation
A) History
B) Local Examination & assessment
C) Investigations
D) X-rays: AP (standing)
Lateral
Long leg films
Pelvis
E) Special tests

CAMPBELL-CIRUGIA ORTOPEDICA. S TERRY CANALE, JAMES H BEATY

 HISTORIA CLINICA
Dolor de rodilla - debe diferenciarse
del dolor de cadera referido

Excluir la claudicacin vascular /

neurolgica perifrica

Enfermedad concurrente, historia

relevante, medicamentos, alergias,
cirugas anteriores y anestsicos
previos

CAMPBELL-CIRUGIA ORTOPEDICA. S TERRY CANALE, JAMES H BEATY

CARACTERISTICAS DEL
DOLOR
_Caractersticas del dolor - inicio del dolor; gravedad;
duracin; afectar el funcionamiento; dolor nocturno;
deteccin, captura o bloqueo notables;
_Tratamientos previos (farmacolgicos, fsicos y terapia
ocupacional)
_Cirugas anteriores
_Tambin discuta pasatiempos del paciente, ocupacin y
metas del tratamiento
 High risk factors for
infection
Pat Patient Related:

Immuno-compromised ( RA, Diabetes,

Steroid use, Advanced age etc. )
Wound healing problems
Obesity
UTI
Dental procedures
 Local examination
Gait analysis
Antalgic gait knee arthritis
Knee thrust gait ligament instability
Trendelenburg gait hip pain
Skin analysis
Signs of infection, including swelling
and rubor
Scars indicating previous operations
Any other lesions in the surgical area
Local examination
Look for gross deformities
Varus
Valgus
Recurvatum
Flexion
Effusion
Patellar tracking
Palpate dorsalis pedis (DP)
artery and posterior tibial
(TP) artery
Local examination
Range of motion
Ligament instability
Hip examination
Knee examination
Radiographic planning why?
Every patient anatomy is
different
Bone resection from
distal femur alter gap
in extension
Bone resection from
proximal femur alter
gap in flexion and
extension
Radiographic
planning
AP weight bearing
radiographs in maximum
extension
Ideally full length standing
scanogram (HKA)
Lateral view in 90o flexion
for assessment of implant size
Every patient anatomy is
different
Lateral radiographs -
importance
Reveal
Posterior osteophytes

Bone loss on tibia

PCL contracture

Loose bodies

Patello-femoral
osteoarthritis
Investigations -
All routine blood investigations
Especially Hb need for blood arrangement, post op
transfusion
S. Creatinine will guide use of post op analgesia
PT/aPTT/INR
Urine routine to rule out occult infection
Specialist consultation (as per pt needs)
Endocrinology DM, hypothyroidism
Cardiology
Nephrology
 Templating sequence
Define the patients anatomy AP Xrays
Plan distal femoral resection AP Xrays
Plan tibial resection AP Xrays
Plan posterior condyle resections Lateral Xrays
Select femoral component size Lateral Xrays
Plan ligament release AP X rays
 Planning of skin incision in
previous scars
Avoid flaps &
undermining of skin
particularly laterally over
patella

Old incisions of prior

menisectomy, which are
either oblique or behind
the midline, can be
ignored.
 Planning of skin incision
in previous scars
Cross transverse incisions at 90.

Include recent parapatellar

incisions in main incision if
practical.

Use most lateral longitudinal

incision if it will allow adequate
access
 CAMPBELL-CIRUGIA ORTOPEDICA.S
TERRY CANALE, JAMES H BEATY
GRACIAS