Master Techniques in Orthopedic Surgery Knee CH27

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PART V Alternatives to Total Knee Arthroplasty

FIGURE 27-7. Drill holes have been made.

FIGURE 27-8. Place the saw guide for the posterior femur cut into the drill holes on the femoral condyle and tap in gently.

necessary to flex the knee to 60° and retract soft tissues. Do not start milling until you are on bone. When ready, push mill in the direction of the femoral shaft. Remove the small rim of bone that was not captured by the spigot. Second and subsequent millings are performed after tibial resection. Put the femoral trial into position (Figure 27-10). Apply the spherical gauge around the femoral trial. Preparation of the Tibia Place the extramedullary tibial guide parallel to the long axis of the tibia in the coronal and sagittal planes (Figure 27-11). Use the G-clamp to fix the tibial guide with a zero resection block and pin the tibial guide in place with one nonheaded pin (Figure 27-12). Place the tibial guide so that the recess is fully seated against the medial aspect on the patellar tendon. We advise noting the depth of resection before completing this cut and advise to switch the zero resection guide to 2 + to avoid overresection. Remove the G-clamp and check the resection level with a C-guide. Use a reciprocat- ing saw to make the vertical tibial cut. Make sure to stay medial to the ACL and aim the blade in the direction of the head of the femur (using the mark placed between ASIS and pubic symphisis).

FIGURE 27-9. After completing the posterior femur cut, compare the size of the discarded fragment to the thickness of the posterior femur on the prosthesis.