PRACTICE PEARLS: Tips and Tricks for Total Knee Arthroplasty
Find out which techniques the experts recommend to improve TKA outcomes.
Faculty members at ICJR South/RLO Course were tasked with sharing their top tips, tricks, and techniques for primary total knee arthroplasty (TKA). Here’s what they had to say.
Kevin L. Garvin, MD
University of Nebraska Medical Center in Omaha
- The incision should be long enough to give the surgeon adequate exposure without putting tension on the skin that could cause skin necrosis and poor wound healing.
- Ensure adequate exposure so that there is good visibility for positioning the components.
- Avoid varus/valgus alignment, as well as flexion or extension alignment, of the tibial cut by aligning the tibial guide with the anterior tibia and not the foot or the ankle.
- The medial third of the tibial tubercle can be difficult to define, so use the tibial eminence and tibial cartilage wear marks to help guide tibial placement and rotation.
- Use intra-articular tranexamic acid to provide hemostasis and limit swelling.
Watch Dr. Garvin’s presentation from the ICJR South/RLO Course
W. Norman Scott, MD, FACS
Insall Scott Kelly Institute in New York, New York
- Remember the “standard” numbers for amount of bone resected from the femur and tibia.
- Cut the proximal tibia perpendicular to the mechanical axis.
- Cut the proximal tibia with a 3° posterior slope.
- Remove posterior osteophytes and release the posterior capsule to manage flexion contracture.
- Combine mechanical alignment with measured resection for component alignment.
Bryan D. Springer, MD
OrthoCarolina in Charlotte, North Carolina
- Make a preoperative plan, including long alignment films, for all primary TKAs.
- Avoid over-release of the superior medial collatera ligament in varus knees to prevent medial laxity in flexion.
- Pay careful attention to the femoral component rotation and posterior condylar resection to avoid flexion instability.
- Use tibial stems in obese patients (BMI > 35).
- Fill tibial defects using screws and cement.
Kim J. Chillag, MD
Palmetto Health Orthopedics in Columbia, South Carolina
- Prepare the patella first, in full extension.
- Grasp the medial meniscus with a clamp and use it as a “handle” to slip in a Cobb elevator and then do a medial release.
- Use a Frazier suction in the tibial canal when cementing the tibia.
Fred D. Cushner, MD
Northwell Health Orthopedic Institute in New York, New York
- Use a pie crust technique to balance the soft tissue in a patient with a valgus knee deformity.
- In a more severe Type II valgus deformity, use a lateral epicondylar osteotomy to balance the soft tissue.
- Good wound closure technique is the key to avoiding hematomas and includes a watertight closure of the arthrotomy, skin edge approximation, and use of smart dressings.
Ormonde M. Mahoney, MD
Athens Orthopedic Clinic in Athens, Georgia
- Use the subvastus approach and release the fat pad from the anterior tibia.
- Use 2 alignment rods in the tibial template to improve tibial alignment.
- Avoid femoral component overhang by downsizing and flexing the femoral component.
- Remove posterior osteophytes from the femur to avoid flexion contracture.
- Use gap balancing to avoid a flexion space that is too tight.