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TKR questions
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TKR questions - January 16, 2001 5:02:00 PM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
Status: offline
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Please forgive my ignorance re: this question. It is something that had not occured to me until I began treating someone with a revision of a TKR. Here goes!! Could anyone please tell me what "happens" to the ACL/PCL with a TKR. I find it hard to believe that these ligaments could be excised and "forgotten" but, anatomically, I see no other option.I have tried research re: the sx but have found no mention of the ligaments. (Actually, there is a "cool" demo of the sx on Orthoclinics.com. as well as the new microscopic endo disectomy procedure). I have observed the sx many years ago but cannot recall the MD pointing out what he was doing with the ligaments.
The patient I am seeing has significant laxity in his tib-fem joint. I do not remember ever having a pt s/p TKR with this problem. (Please note: I have not seen pts s/p TKR in years due to no contract with Medicare until recently). In any case, this particular patient had a revision of a TKR in November. I began seeing him at the end of Dec. He is doing fairly well with 0-95 degrees AROM. 5-10 degrees quad lag which is an improvement (was 25 degrees). No c/o pain but c/o a loose feeling in his knee. Upon examination, positive Lachman's test with palpable clunking. Is this normal???? Surely doesn't feel "normal" to me.
Also, while I'm at it....at a seminar approx 10 years ago , I learned that with a TKR, one should not expect to achieve more than 90 degrees of flexion. The reason supporting this is because the prosthesis can anterior glide but not dorsal tilt. Therefore, without the dorsal tilt (which occurs after 90 degrees) no flexion greater than 90 degrees could be achieved . If further flexion is achieved, it is slippage of the tibia on the femur. Now, maybe someone could direct me to a site that gets into the specific biomechanics of the prostheses that are used and changes that have been made (hopefully) over 10 years.
Again, I apologize if I sound ignorant. (I am actually afraid Drew is going to blast me like he has done in the past with people who ask "stupid" questions.) Drew????
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Re: TKR questions - July 16, 2001 6:36:00 AM
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cheapo
Posts: 9
Joined: February 3, 2000
Status: offline
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Just sharing my experience...
I have done ligamental tests on my TKR patients and found that many of them has a postive anterior drawer test. A check with my senior confirms that in most TKR (major ones) the cruciate ligaments are usually sacrificed. It has something to do with replacing the knee surface with prosthetics.
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Re: TKR questions - July 16, 2001 8:14:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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Bonmar:
Don't get many TKRs with this crowd but here is a little of what I remember.
I THINK that in most surgeries the cruciates are sacrificed. I beleive that the prosthesis has an element that will help maintain stability. I do remember hearing about PCL sparing surgery in which a different prosthesis is used and the PCL is maintained. Again....not sure.
mcap
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Re: TKR questions - July 17, 2001 11:06:00 AM
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edvol
Posts: 8
Joined: May 24, 2001
From: Israel
Status: offline
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They cut them off. I've been on the procedure.
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