Knee Arthroplasty: The accuracy of Pre-operative Templating

By PeekMed on August, 26 2019

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    Preoperative planning is recommended for every type of surgery and preoperative templating has become very popular since the planning of orthopedic surgical procedures became a habit in knee arthroplasty.

    Many studies have reviewed the accuracy of templating in both primary knee and hip arthroplasty. The templating must not be taken as an absolute guide but only as a general lead of the size of the prosthesis to be inserted.

    Templating is excellent at predicting the size of primary prostheses to one size, or to two possibilities, one larger or smaller than the right dimension. This decreases the need for a wide range of extensive and less used stock to be kept on site and permits you to order the right amount of necessary sizes on demand, resulting is an overall greater cost efficiency.

    Nowadays, there is an obvious and rising interest in the search for new digital tools that will help you get better results in your daily life.

    PeekMed has a feature that works for all subspecialties, the template database, which is automatically updated to show only the templates for the chosen subspecialty, in order to make the search easier.

    Upon selection, the template is automatically added to the image and is placed based on real surgical considerations. Usually, the template library is updated on a monthly basis. The location of the templates depends on the environment in which the planning is made:

    • 2D environment: the 2D template appears on each of the 2D images taking into account their orientation.
    • 2D / 3D environment: 2D template emerges on the 2D image, taking into account the orientation of each image and the 3D template section will be placed in 3D;
    • 3D Environment: you can only enter the 3D template in the 3D section;

    The complications of this type of surgery can be divided into three categories:

    • Complications specific to the operative procedure;
    • General perioperative complications (anesthesia related);
    • Other medical complications (postoperative complications).

    Perioperative complications may include blood loss, infection, early hemorrhage and wound breakdown, intraoperative complications, and anesthetic, as well as respiratory, cardiovascular or renal problems.

    knee arthroplasty templating

    Since knee arthroplasty is a major surgery, the pre operative planning, medical consults and physical evaluations start usually a month before the set date for the surgery.

    During the surgery, the knee joint bone cuts are made perpendicular to the distal femur, typically using an intramedullary alignment system which is checked against the center of the hip.

    As a result, the proximal tibia is cut perpendicular to the mechanical axis of the tibia, using either intramedullary or extramedullary alignment rods.

    It is important to allow optimum load sharing and prevent eccentric loading through the prosthesis.

    Enough bone needs to be removed so the prosthesis recreates the level of the joint line – the ligaments around the knee might be contracted because of the pre-operative deformity and must be carefully released in a stepwise fashion. If the patellofemoral joint is significantly worn, it can be resurfaced with a polyethylene button.

    Once the definitive prosthetic components have been selected, they are cemented into place with polymethylmethacrylate cement.

    Foot pulses must always be checked at the end of the procedure.

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