Total Knee Replacement Surgery Eric W Janssen
I'm Eric Janssen with SportsMED in Huntsville, Alabama. I'm performing a total knee replacementon a 58yearold male patient who presented to us with stiffness,pain and swelling secondary to arthritis. After meeting with him in the preoperativearea, he comes back to the operating room where the staff will get him ready for the surgery. During this period of time myself andour assistants will review the case prior to starting it.Including the xrays and any significant technical issues that we may have to address,which we have done prior to the
surgery as well. Once the patient is asleep we evaluatethe knee including prior incision sites as well as his range of motion and stability. We are now ready to start the operationwhere we make the initial skin incision and then we will subsequently go beside theknee cap or patella to the inner side of the knee for our deep exposure. Once we have made our incision beside thepatella or knee cap we will evert it over and remove the soft tissues includingthe fatty layer around the patella itself.
Next we will go ahead and remove the largespurs or osteophytes that way we will have a good idea of what we are dealingwith in terms of the size of the patella. We will actually measure the thickness of itand know then how much we have to remove. Here you see the device attached toa planing device and we will remove a certain thickness of thebone flattening off the patella itself. We then will measure the size the patellain terms of its circumference and pick a size of a patella button.Here you see the guide that we will place on the patella where we will ream the holes forthe pegs and then remove any remaining
osteophytes at that time. Now we place the protector guide in placeand turn our attention to the thigh bone or the Femur. Initially we will place a pilot hole intothe femur and here you can see the intramedullary guide with our distalcutting block attached. The saw will be used to make a cut on thevery end of the femur to get our alignment and bone off as you can see here. We will then remove some of the spursfrom around and measure the size of the
femur and place on ournext cutting block. Our anterior, posterior, and temporal cutswill then be made on the femur or the thigh bone at this time. The guide is subsequently removed and allthe bony fragments removed as well. Once again osteophytes are removed and thenwe turn our attention to the lower bone or the tibia.Here you can see us making a pilot hole; our intramedullary guide is nowplaced with our cutting block. We then remove the intramedullary guideand use our saw to make our cut on the
lower bone or the tibia.Here we elevate the bone up; we will then remove it off andhave a flat cut on the tibia. We then remove any excessive soft tissuefrom around the knee and you can see here how worn this piece really is. Our trials are then placed in with thelower tibia bone first and then the upper component is placed on and a small cutis made to finish the groove for the patella. Our trials are then placed in so that wecan determine what size thickness of the polyethylene we want for the knee.
Hip and Knee Osteoarthritis Guideline for Nonsurgical Management
Hello, I'm Norman Swan. Welcome to this programon the new guidelines for the nonsurgical managementof hip and knee osteoarthritis. It's a timely program, as we're broadcastingduring Arthritis Awareness Week. Arthritis, as you know, is a major causeof disability and chronic pain. There's around 100 different formsof arthritis, and osteoarthritis is the most common.
This program is the thirdin a series of four on the musculoskeletal guidelines that have been developedby the Royal Australian College of GPs and approved by the NH and MRC. This program will cover the diagnosisof osteoarthritis and discuss recommendednonpharmacological and pharmacological interventions in a multidisciplinaryprimary healthcare setting.
As always,you'll find a number of resources available on the Rural Health EducationFoundation's website: Let's meet our panel. Geoff McColl is a rheumatologistand professor of Medical Education and Trainingat the University of Melbourne. Welcome, Geoff. Thank you, Norman. Geoff is the current president ofthe Australian Rheumatology Association and was part of the working partydeveloping this guideline.
Rana Hinman is a physiotherapistand senior lecturer in the University of Melbourne Schoolof Health Sciences. Welcome, Rana. Rana has particular expertisein evaluating conservative treatments for osteoarthritis, and was alsoa member of the working party. Michael Yellandis a general practitioner and associate professorof Primary Health Care at Griffith University in Queensland.Welcome, Michael. His teaching and research interestsfocus on evidencebased diagnosis
and the treatmentof musculoskeletal pain. And David Ng, who's a pharmacist and director of the South Australianand Northern Territory Branch of the Pharmaceutical Societyof Australia. Welcome, David. Thank you, Norman. From the home of fish oil. That's correct. We'll talk about fish oil later to see whether or not it'sthe magic panacea for osteoarthritis.
Many myths about osteoarthritis,Geoffreyé There are many myths, Norman. Probably the best place to start is that this is an illness that you acquireas you grow old that you can do nothing about. You're just going to creak your wayto the wall at the bottom of the garden. Absolutely. There's a certain acceptancethat this is the way it will be. NORMAN:Are you telling me it's reversibleé