10 commandments to straight knee during tkr wiroc 2015 mumbai
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Transcript of 10 commandments to straight knee during tkr wiroc 2015 mumbai
10 COMMANDMENTS TO A STRAIGHT KNEE
Dr Vaibhav BagariaJoint Replacement Surgeon
Sir HN Reliance Foundation HospitalMumbai India
#1 Thou Shalt Do clinical assessment
Do not succumb to temptation of sloth, Laziness, or avoiding inconvenience by neglecting due diligence
Not to miss!
• Previous Scars
• Sagital & Coronal Plane deformity
• Stability
• PFJ
• Extensor Mech
• Hips/ Foot/ Spine
• Distal Pulses
#5: Thou shall take proper Tibial Cut
• Tibial Cut is perhaps the most important cut - your foundation cut
• Choose appropriate strategy: Intramedullary or Extramedullary
• Do not be dogmatic!!!
A word about Gadgets
Do not Miss out on a great Investment because of fees. Be willing to pay when expense add value
You Must strike a balance: Do not be a miser and dogmatic for technology And do not be wasteful by using gadgets unnecessary
without receiving a value added benefit.
Do not need car to go home, do you?
CAS great for EM deformity, Complex primaries & when you do not wish to cannulate
#7: Thou Shalt understand Ext Rotation Philosophy
• Epicondylar axis
• Posterior condylar referencing
• Whiteside line
• Parallel to Tibial Cut
#8: Thou shalt prepare for special conditions
• Post traumatic
• Post HTO
• Pagets disease
• Large deformities
• Poor bone stock and bone loss
#9: Thou Shalt check check & recheck
Getting better at TKR is largely governed by good mathematics.
It is a science accomplished by artful work built around the core principle of mathematical expectation
Do not Gamble: Insurance companies do not gamble and neither do casino owners.. only their customers do! So should you??
So check, check recheck!!!
#10: Thou Shalt learn from your own mistake
The greatest obstacle to discovery is not ignorance - Its the illusion of Knowledge
- D J Boorstin
Invest in your self: Train, Learn, Grow!!!
10 Commandments of Straight TKR
• Clinical Assessment
• Understanding Biomechanics
• Preoperative planning & Tempting
• Releases
• Tibial Cut - Foundation
• Femur cut philosophy
• ER Set
• Check check Recheck
• learn from mistakes