102 episodes
Total Knee Tips & Pearls From Dr. Adam Rosen (A Virtual Total Knee Fellowship Podcast) Dr. Adam Rosen
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- Health & Fitness
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5.0 • 9 Ratings
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Dr. Adam Rosen is an orthopedic surgeon who specializes in total joint replacement. He created this podcast which is aimed at interns, residents, fellows, and general orthopedists who are looking to dive into the details of total knee replacements. I do not claim that my way is the best way or the only way. My personal approach to my patients, total knee replacement surgery and the ever important post-operative recovery has been developed over the years. My protocols are ever changing based on scientific evidence and personal experience.I know many of you will want to jump right ahead to the operative step episodes - and that is okay. The first few episodes are not as exciting but they do contain important information in my opinion. If you jump ahead just be sure to come back and listen to the first few episodes.I will attempt to offer you my brain and the algorithm within it. Here I will share my thoughts and my approach to caring for total knee replacement patients. I hope that you learn something from this podcast. I hope that my thought process stimulates your thinking and approach. Most importantly I hope that I can offer one or more tips or pearls that may benefit your patients. If you like the information and have a friend or colleague that you think would benefit from the material please be sure to share this podcast with them. (Disclaimer: This is my opinion. Any information gathered is not medical education. Practitioners need to use their education and experience to determine how to treat their own patients.)
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Balancing Algorithm in TKA
Most gunners, interns and residents have memorized "the chart." That chart with what to do in a TKA when flexion is loose or the extension gap is tight or vice versa. Here I want to review that and more and discuss the things that I look for during balancing.
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Using a Star System for Difficult Cases
In my first year of practice I remember a day where I only had three joints but it took all day and I was exhausted. Although they were all primaries they each had a component that made them hard - size, bone loss, stiffness.
I created a system that allowed me to communicate with my scheduler so they could spread out the hard cases which prevented one day from having all chip shot easy cases and another day which had all of the hard cases.
I hope you find this tip helpful in your practice.
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The Outerbridge Classification
This is the first in a series of episodes where I review some classic articles and classifications.
The Outerbridge classification was first presented in JBJS-B in 1961
The classification is as follows:
1 - Softening and swelling
2 - Fragmentation and fissuring less than 1/2 inch diameter
3 - Fragmentation and fissuring greater than 1/2 inch diameter
4 - exposed bone
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Patella Clunk
Although rarely seen with newer TKA designs this was a diagnosis seen in patients with TKAs and could be extremely symptomatic.
Patellar clunk was first described by Hozack et al in 1989.
Patellar clunk occurred when a fibrous nodule forms above the patella. This nodule would get caught in the intercondylar notch in flexion and then cause a painful clunk as patients whet from flexion into extension.
This is a clinical diagnosis.
Patients tend to do well with arthroscopic debridement when there are no radiologic abnormalities such as loosening or malposistion.
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HO - Brooker Classification
Brooker et al JBJS Vol 55-A 1973
Class I - Islands of bone within the soft tissue around the hip
Class II - Bone spurs from the pelvis or proximal femur , leaving at least 1 cm between
Class III - Bone spurs from the pelvis or proximal femur, reducing the space between to less than 1 cm
Class IV - bony ankylosis
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Fairbank
Knee Joint Changes after Meniscectomy by T.J. Fairbank
published JBJS - Br 1948
The following radiological changes were seen after meniscectomy
1. Ridge formation
2. Narrowing of the joint space
3. Flattening of the femoral condyle
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