File Name: smith and nephew genesis ii surgical technique .zip
Log In Sign Up. Download Free PDF. Long-term results of posterior-cruciate-retaining Genesis I total knee arthroplasty George Petsatodis. Byron Chalidis. Pericles Papadopoulos. Anastasios Christodoulou. Download PDF. A short summary of this paper. Long-term results of posterior-cruciate-retaining Genesis I total knee arthroplasty. IntroductionThe number of total knee arthroplasty TKA procedures performed each year is predicted to gradually increase .
As indications grow and younger patients are becoming candidates for this type of operation, the demands for a better and newer prosthesis that will fulfill all expectations are steadily increasing . Also, it has a minimally conforming polyethylene bearing surface, which is made up of ultrahigh molecular weight polyethylene and a dome-shaped polyethylene patellar component with a central fixation peg .
Modular components, such as optional stems, wedges, and augments, allow great intraoperative versatility in both primary and revision situations. Few trials have been published presenting midterm results of Genesis I prosthesis in knee osteoarthritis . Materials and methods Study designThis study was a retrospective cohort analysis level III, therapeutic study. The arthroplasty database of the hospital B. Papanikolaou'' Hospital, Exochi, Thessaloniki, Greece e-mail: byronchalidis gmail.
The study was approved by the hospital ethical committee. Furthermore, anteroposterior AP and lateral knee radiographs were reviewed by two independent observers one for each patient to measure limb and prosthesis alignment and detect radiolucent lines .
Interobserver agreement between investigators was not assessed. The Knee Society total knee arthroplasty roentgenographic evaluation system  was used to determine any radiolucent lines around the femoral and tibial components.
Radiolucency around the tibial component was determined from both AP and lateral knee views. From the AP view, zones 1 and 2 represent the area beneath the medial plateau, zones 3 and 4 the area beneath the lateral plateau, and zones 5, 6, and 7 the keel area. In the lateral view, radiolucent zone 1 is anterior, zone 2 is posterior, and zone 3 is at the tip of the keel.
Radiolucency around the femoral component was determined in seven zones on the lateral X-ray. Zones 1 and 2 represent the area behind the anterior flange; zones 5, 6, and 7 represent the stem or central area; zones 3 and 4 represent the posterior part of prosthesis. No intraobserver or interobserver analysis of radiographic findings was performed. Surgical technique managementAll patients were placed in the supine position, and a tourniquet was applied in the ipsilateral thigh.
Routine antibiotic prophylaxis with intravenously administered cefuroxime 1. A midline skin incision of approximately cm and a medial parapatellar arthrotomy were used. The retropatellar fat pad was sharply excised along with the menisci and anterior cruciate ligament ACL. Overhanging osteophytes were removed from the femur and tibia. In all cases, the PCL was maintained, and the patella was not replaced. However, detailed patellar debridement, removal of unstable cartilage fragments or drilling of subchondral bone in case of complete cartilage absence, thorough peripatellar synovectomy, and circumpatellar cautery denervation were performed.
Trial implants then were placed over the resected bone surfaces, and joint stability, ligament balance, and ROM were subsequently assessed. In case of persistent flexion contracture, PCL and posterior capsular release at the femoral side were performed.
All tibial components were cemented, whereas femoral components were fixed with or without cement. The issue of cementing or not cementing the femoral prosthesis was at surgeon's discretion according to bone quality and trial component stability. Suction drains were routinely used, and the tourniquet was released before wound closure.
Postoperative physiotherapy was identical for all patients. Continuous passive motion was initiated on day 1. Full weight bearing was commenced on day 2 postoperatively under physiotherapist's supervision. After hospital discharge, low molecular weight heparin LMWH was prescribed for 1 month. Patients were reviewed clinically and radiographically after 6 weeks, 3 months, 1 year, and then annually.
Data are presented as number of cases with percentage or as mean and range. The t test was used to compare parametric variables. For the purpose of survivorship analysis, three Kaplan-Meier survivorship curves were created.
The radiographic probability of the survival curve was referred to revision surgery due to gross evidence of component loosening, change of implant position, or progression of radiolucent lines.
The clinical probability of survival curve was estimated taking into account all other reasons responsible for TKA failure, such as infection and stiffness. The total probability of survival curve summed up all conditions that led to prosthesis revision.
Results Clinical findingsThere were 62 men and women, with a mean age of 69 range years right and left knees. Average body mass index BMI was Mean follow up was Primary osteoarthritis knees was the most common indication for TKA, followed by rheumatoid arthritis 18 knees , posttraumatic arthritis eight knees , hemophilic arthropathy one knee , and osteonecrosis three knees.
Radiographic findingsMean tibiofemoral angle shifted from 2. The femoral component was positioned in Angles for the tibial component were However, in only five cases 1. Radiographically, none of these five patients had component malalignment. However, two patients were obese BMI Another revision TKA 0.
Although no injury was mentioned, the patient ignored the instructions to avoid strenuous and intense farming activities. These included persistent wound drainage [. One TKA revision 0. Delayed-onset infection treated with two-stage revision arthroplasty was reported in three knees 0. Two osteoporotic women patients 0. However, no revision was required. Survivorship analysisOverall survivorship of knee replacement reached The Kaplan-Meier survivorship curves showing clinical, radiographic, and total probability of TKA are presented in Fig.
DiscussionGenesis I total knee prosthesis achieved satisfactory survivorship rates. Mokris et al. Chen et al. Ishii et al. Our study of patients who underwent a Genesis I knee replacement with PCL retention and nonresurfacing of the patella showed a As far as we know, this is the largest study of Genesis I patients with the longest follow-up published so far.
Studies examining the Genesis I design showed significant improvement in pain relief, ROM, and knee function . KSS pain and functional scores increased from preoperative averages of 55 and 44 points to 92 and 88 points, respectively. The incidence of radiolucency around knee components can be widely varied. Lotke and Ecker  advocated that malposition of the tibial component, especially in varus, was a major factor for the presence of radiolucent lines around the tibial component.
However, radiolucent lines are not always indicative of implant loosening or poor outcome . He hypothesized that the low rate of radiolucency was due to optimum position of the tibial component. The radiolucent lines were in zones 1 for the femoral component and in zones and 1 and 4 for the tibial component. Debates over whether the PCL should be preserved or the patella should be resurfaced in TKA have been ongoing for several decades.
Multiple reviews of the literature have not found sufficient evidence to recommend evidencebased and consensus guidelines . A recent metaanalysis was undertaken to pool the results of randomized controlled trials RCTs and to compare the outcomes and postoperative complications after TKA with patellar resurfacing or nonresurfacing . Results indicated that patellar resurfacing would reduce the risk of reoperation after TKA, but the benefits were limited on other aspects, and the analysis of high-quality studies showed no advantage of resurfacing over nonresurfacing, even in the aspect of reoperation risk.
Also, it may enable better knee function in activities such as climbing stairs and allow normal rollback of the femur on the tibia, thus improving deep flexion. On the other hand, ligament balancing and correction of knee deformity are more difficult with PCL retention. A loose PCL may lead to instability and pain, whereas a tight PCL may restrict knee flexion and lead to high stress concentration in the polyethylene liner .
The outcome was comparable between groups. We found that PCL retention and nonresurfacing of the patella even in patients with rheumatoid arthritis provides excellent long-term results and a low complication rate.
Although the combination was not associated with a high revision rate, it might influence knee performance. We believe that any flexion instability due to potential PCL insufficiency, or some anterior knee pain due to the nonresurfaced patella, might be underestimated, as we found they did not cause significant disability, particularly in lowdemand patients. To what extent meticulous patella preparation and protection of PCL integrity during surgery attributed to good functional outcome, as recorded in this study, is not quite clear.
Metrics details. Osteoarthritis of the knee is a common condition that is expected to rise in the next two decades leading to an associated increase in total knee replacement TKR surgery. CAPAbility is a pragmatic, blinded, two-arm parallel, randomised controlled trial recruiting patients with primary osteoarthritis due to have unilateral TKR surgery across two UK hospitals. Baseline measures will be taken prior to surgery. Patients will be followed at 1 week, 6 to 8 weeks and 6 months post-operatively. Secondary outcomes include: other PROMs, biomechanical, radiological computerised tomography, CT , clinical efficacy and safety outcomes.
Implant function is directly related to accurate surgical technique. GENESIS II instrumentation has been developed to be an easy-to-use system that will assist the surgeon in obtainingaccurate and reproducible knee alignment. The instrumentation can be used in minimally invasive or standardexposures. While it has been the designers objective to developaccurate, easy-to-use instrumentation, each surgeon must evaluatethe appropriateness of the following technique based on his or hermedical training, experience and patient evaluation. Robert B. Steven B.
The features of this device include a deeper and more lateralized trochlear groove than earlier designs, an externally rotated femoral component meaning the femoral cuts are performed in neutral rotation relative to the epicondylar axis, but the implant has a thicker posterolateral femoral condyle to compensate and an anatomic asymmetrical tibia. The system is said to allow compatibility between a femoral component of a given size and up to four sizes of tibia. Available versions include cruciate retaining, posterior stabilized, and constrained arthroplasties. Components can be porous or non-porous. High flexion knee and deep-dished tibial inserts are available, as is an all-polyethylene tibia in cruciate retaining or posterior stabilized versions.
Table Of Contents. Quick Links Download this manual. Surgical Technique.
Quick Links Download this manual. Surgical Technique. Single use negative pressure wound therapy system 8 pages. Low-intensity ultrasound fracture healing system for the treatment of nonunion and fresh fractures 32 pages. Page 2 In consultation with: Professor T.
У тебя неверные данные. - Ты это уже. - Вот. Она нахмурилась. - Ты не заметил ничего. Ну, может, дошел какой-нибудь слушок.
Сбои техники в Третьем узле были такой редкостью, что номера ошибок в ее памяти не задерживалось. Сьюзан пролистала справочник и нашла нужный список. 19: ОШИБКА В СИСТЕМНОМ РАЗДЕЛЕ 20: СКАЧОК НАПРЯЖЕНИЯ 21: СБОЙ СИСТЕМЫ ХРАНЕНИЯ ДАННЫХ Наконец она дошла до пункта 22 и, замерев, долго всматривалась в написанное. Потом, озадаченная, снова взглянула на монитор. КОД ОШИБКИ 22 Сьюзан нахмурилась и снова посмотрела в справочник. То, что она увидела, казалось лишенным всякого смысла. 22: РУЧНОЕ ОТКЛЮЧЕНИЕ ГЛАВА 35 Беккер в шоке смотрел на Росио.
Вирусы. Холод пронзил все ее тело. Но как мог вирус проникнуть в ТРАНСТЕКСТ. Ответ, уже из могилы, дал Чатрукьян. Стратмор отключил программу Сквозь строй. Это открытие было болезненным, однако правда есть правда. Стратмор скачал файл с Цифровой крепостью и запустил его в ТРАНСТЕКСТ, но программа Сквозь строй отказалась его допустить, потому что файл содержал опасную линейную мутацию.
Хейл побледнел. - Что это. - Стратмор только сделал вид, что звонил по телефону. Глаза Хейла расширились. Слова Сьюзан словно парализовали его, но через минуту он возобновил попытки высвободиться.
Постепенно она начала понимать. Время сердечного приступа настолько устраивало АНБ, что Танкадо сразу понял, чьих это рук дело, и в последние мгновения своей жизни инстинктивно подумал о мести. Энсей Танкадо отдал кольцо, надеясь обнародовать ключ. И теперь - во что просто не верится - какой-то ни о чем не подозревающий канадский турист держит в своих руках ключ к самому мощному шифровальному алгоритму в истории. Сьюзан набрала полные легкие воздуха и задала неизбежный вопрос: - И где же теперь этот канадец.
Всю ответственность я беру на. Быстрее. Хейл выслушал все это, не сдвинувшись с места и не веря своим ушам. Хватка на горле Сьюзан слегка ослабла.
Hinduja National Hospital, Mumbai, India.Alcides M. 05.12.2020 at 23:00
Subscribe to get full access to this operation and the extensive Knee Surgery Atlas.Matthew B. 11.12.2020 at 21:49
orthopaedic surgeon solutions to address intraoperative situations. Implant function is directly related to accurate surgical technique. GENESIS II instrumentation.Frowmorrresme1954 12.12.2020 at 09:21
to offer the orthopaedic surgeon solutions to address intraoperative situations. Implant function is directly related to accurate surgical technique. The GENESIS II.Nydia R. 12.12.2020 at 17:21
GENESIS II Total Knee System includes knee implants that are cruciate retaining, Overview; Design and Materials; Techniques and fewer in number, reduces surgical time, makes intraoperative management easier, PDF ( KB).