Chapter-02 Total Knee Replacement (Cruciate-Substituting Fixed Bearing TKR)

BOOK TITLE: A Practical Operative Guide for Total Knee and Hip Replacement

1. Mehta Ajit Kumar
Publishing Year
Author Affiliations
1. Orthopaedic and Joint Replacement Centre, Jagjivan Ram Hospital, Mumbai, India, Orthopedic and Joint Replacement Center, Jagjivan Ram Hospital, Mumbai, Maharashtra, India, Jagjivan Ram Hospital, Mumbai, Maharashtra, India
Chapter keywords


Open the knee joint by midline skin incision and medial parapatellar approach. Do sequential soft tissues release. Adequate soft tissue balance preserves bone stock and reduces cement bone interface stress which prevents early failure. Remove osteophytes, infrapatellar fat pad, medial meniscus, lateral meniscus, ACL, PCL, supracondylar synovectomy and release of patellofemoral plicae. Do tibial cut perpendicular to tibial axis (0 mm on more involved condyle or 8 mm or maximum 10 mm on less involved condyle) with usually 3 degree posterior sloped tibial cutting block. Do Femoral cuts (7 degree valgus, 9 mm thickness, 3 degree external rotation) – 6 cuts, distal, anterior, posterior, anterior and posterior chamfer and box cuts. Upper surface of tibia has 3 degree varus slope. So cut the tibia at 90 degree to the mechanical axis of tibia and this 3 degree varus slope of tibia is compensated by 3 degree externally rotating the AP cutting block of femur and cutting more posterior part of medial condyle of femur and creating rectangular space at 90 degree flexion of tibia (i.e. rectangular flexion gap). If 3 degree external rotation of AP cutting block is not done then the space between femur and tibia at 90 degree flexion will be trapezoidal (i.e. trapezoidal flexion gap) which will lead to tight medial collateral ligament and lax lateral collateral ligament on flexion of knee at 90 degree. Check rectangular and equal flexion-extension gap. Do resurfacing of patella and drilling for 3-pegs of patellar implant in superiorly and medialized position. Do tibial preparation in 3 degree external rotation. After pulse lavage, do cementing of patella, femoral component and tibial tray in sequence. Apply appropriate size and thickness of tibial insert, reduce and extend the knee. Apply two drains and suture the wound in layers.

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