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Revision Knee Arthroplasty CLINICAL CASES

LEGION Revision Knee System. Revision Knee Arthroplasty CLINICAL CASES. by Marc CLEMENS MD & Yvan BARTHOLOME MD. Clinical Cases. 3 clinical cases. 3 different problems. Learning time and complications. Discussion. Clinical Cases. Clinical cases - 3 different problems.

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Revision Knee Arthroplasty CLINICAL CASES

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  1. LEGIONRevision Knee System Revision Knee ArthroplastyCLINICAL CASES byMarc CLEMENS MD& Yvan BARTHOLOME MD

  2. Clinical Cases • 3 clinical cases • 3 different problems • Learning time and complications • Discussion

  3. Clinical Cases • Clinical cases - 3 different problems • 1 - Allergy - Bone defect • 2 - Osteolysis • 3 - Classical TKA revision Patellar sub-dislocation

  4. Case 1 C. Simone • Woman - 71 years old • Surgical past : Patellar fracture

  5. Case 1 C. Simone • Woman - 71 years old • Surgical past : 1998 Total Knee Arthroplasty (Nickel-Chrome-Cobalt)

  6. Case 1 C. Simone • Woman - 71 years old • Surgical past : 1998 - 2000 Allergy - Nickel !!!

  7. Year 2000Femoral revisionGenesis II (Zirconium -3) Case 1 C. Simone • Woman - 71 years old • Surgical past :

  8. Year 2001Release of the Lateral Patellar Retinaculum(small sub-dislocation) Case 1 C. Simone • Woman - 71 years old • Surgical past :

  9. Case 1 C. Simone • Woman - 71 years old • Surgical past : 2002 Cement “disease” + Allergy +++

  10. Year 2003 Tibial Revision(Full Poly - Size 15 - Max)Dermatologist error !Allergy to Titanium Case 1 C. Simone • Woman - 71 years old • Surgical past :

  11. Case 1 C. Simone • Woman - 71 years old • Surgical past : Persistence of a large knee laxity + Allergy

  12. Year 2007 LEGION(Cement Simplex Antibiotic) Case 1 C. Simone • Woman - 71 years old • Now :

  13. Femoral implants:Legion Oxinium size 4Stem 18 mm x 120 mmL-wedge 10 mm dist(x2) 10 mm post Patellar implant:26 mm biconvex Tibial implants:Legion baseplate size 36 mm offset couplerStem 22 mm x 120 mm21 mm posterior stabilized articular insert Case 1 C. Simone • Technical data

  14. Case 1 C. Simone • Woman - 71 years old • Post operative incident : Year 20071 week post-op LEGION Fracture underthe TKA

  15. Case 2 H. Lucienne • Woman - 73 years old • Surgical past : 1975 Maquet

  16. Case 2 H. Lucienne • Woman - 73 years old • Surgical past : 1979 Tibial Osteotomy

  17. Case 2 H. Lucienne • Woman - 73 years old • Surgical past : 1987 Emslie

  18. Case 2 H. Lucienne • Woman - 73 years old • Surgical past : 1990 Pseudarthosys of TTO

  19. Case 2 H. Lucienne • Woman - 73 years old • Surgical past : 1992 Arthroscopy

  20. Case 2 H. Lucienne • Woman - 73 years old • Surgical past : 1993 Total Knee Arthroplasty (Freeman - cemented femoral implant - uncemented tibial implant)

  21. Case 2 H. Lucienne • Woman - 73 years old • Surgical past : 1994 TKA Revision (Patella pain - femoral implant)

  22. Case 2 H. Lucienne • Woman - 73 years old • Before our operation : RecurvatumPainTibial osteolysis

  23. Case 2 H. Lucienne • Woman - 73 years old • Now : 2007 TKA RevisionLegion - Offset

  24. Femoral implants:Legion Oxinium size 46 mm offset coupler Stem 15 mm x 160 mmL-wedge 15 dis x 5 posWedge 5 mm Patellar implant:29 mm biconvex Tibial implants:Legion baseplate size 36 mm offset couplerStem 15 mm x 220 mm15 mm posterior stabilized articular insert Case 2 H. Lucienne • Technical data

  25. Case 3 H. Albert • Man - 71 years old • Surgical past : 1991 Arthroscopy

  26. Case 3 H. Albert • Man - 71 years old • Surgical past : 2002 Quadriceps tendon pulling up

  27. Case 3 H. Albert • Man - 71 years old • Surgical past : 2006 Total Knee Arthroplasty (Tibial osteolysis, medial rotation, patellar sub-dislocation)

  28. Case 3 H. Albert • Man - 71 years old • Now : 2007 TKA Revision Legion

  29. Femoral implants:Legion Oxinium size 7Stem 18 mm x 160 mmL-wedge 10 dis x 5 posL-wedge 5 dis x 5 pos Patellar implant:29 mm biconvex Tibial implants:Legion baseplate size 7Stem 16 mm x 160 mm13 mm posterior stabilized articular insert Case 3 H. Albert • Technical data

  30. LEGIONRevision Knee System Bono JV, Roger DJ, Laskin RS, Peterson MGE,Paulsen CA. Tibial intramedullary alignment in total knee arthroplasty. 1998;13(2):241. Conclusion For the tibial insert:This revision system is based on an intramedullary guide.Post scriptum : the anatomic axis approached the mechanicalaxis to within 1° on averagein both the anteroposterior and lateral planes.

  31. LEGIONRevision Knee System Diaphyseal engaging stemcausing malalignment ina tibia with valgus bowing. Thomas K. Fehring. Use of Stems in Revision Total Knee Arthroplasty. Revision Total Knee Arthroplasty. James V. Bono. Richard D. Scott Editors. 2005;13:137-144 Conclusion It’s not like other revision knee systems where the direction of the tibial base plate restricted by the bone defects (+ grafts) determines the axis of the stem. In such case, the use of long implants transfers stress from the deficient plateau to the shaft and might cause significant periarticular stress shielding.

  32. LEGIONRevision Knee System Conclusion With the LEGION Revision Knee System,it’s necessary to have optimal length and width of stem to obtain a stable primary fixation. To restore the anatomical axis of the tibial plateau; offset couplers, hemi-angled, hemi-stepped, full-angled or full-step wedges are available.

  33. LEGIONRevision Knee System Conclusion This complex LEGION Revision Knee System allows the re-establishment of a balanced biomechanical knee arthroplasty and a favourable distribution of the stress shielding on the bone.

  34. LEGIONRevision Knee System Conclusion In practice :Use preferably long stem thansmall and large stemto have a gooddistribution of loads

  35. LEGIONRevision Knee System -1 mm 14mm13mm11mm14mm Reamer size Conclusion • In case of :press-fit stem and osteoporosys ofsmall bone corticaltake an implant 1 mm narrower than the last reamer size to avoid excessive constraints on bone structures.

  36. LEGIONRevision Knee System X Conclusion • When you have assembled the tibial base trial, the offset coupler and the stem,NEVER USE AHAMMERwith thetibial baseplate impactorto insert the trial into the tibia.

  37. LEGIONRevision Knee System Conclusion • USE the LONG STEM EXTRACTOR TOOL and THE UNIVERSAL EXTRACTORto avoid compressing the trial J-hook systemand assess wrongly the correct length of the stem.

  38. LEGIONRevision Knee System Conclusion • All these conclusions are particularly valid in case of :- old patient- obesity- osteoporosys- large bone defect- tibial implant

  39. LEGIONRevision Knee System Thank You for your attention

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