Krishna Tripuraneni, MD
Krishna Tripuraneni, MD is a fellowship-trained orthopaedic surgeon at New Mexico Orthopaedics in Albuquerque, NM specializing in total knee and hip replacement. He uses digital pre-operative planning to prepare all of his total joint procedures and has been using OrthoView for six years.
The patient was an 86 year-old woman who was the primary caregiver for her husband and had previously been an active person in the local community. She was experiencing increasing right knee pain and deformity and was unable to walk without the use of a cane. Even mundane daily activities were considerably more challenging as a result of her right knee pain and swelling. A physical examination revealed antero-posterior and medial instability with 10-degree hyperextension to 90-degree flexion
Due to gross component loosening on radiographs and functional limitations, a revision knee procedure was planned. Using the OrthoView pre-operative planning solution, the following pre-operative considerations were identified and incorporated into the surgical plan:
– It was identified that stemmed components were required for both the tibia and the femur.
– We determined that a tibial augment was required as a result of the varus failure of the tibial component and medial tibial bone loss.
– The offset value provided by the software identified that an offset tibial component was required to avoid an abutment of the cortex by the tibial stem.
- Joint line:
– We were able to assess how the pre-operative plan would affect the joint line and determined that it would maintain it reasonably well.
- As there was intra-operative hyperextension, tibial augments and a 17 mm polyethylene were used to balance the extension space (in addition to distal femoral augments), which caused the joint line to be raised by a few millimeters.
- A hybrid cementation technique was used for this case.
- The post-operative ROM at the one-year follow up was found to be 0-115 degrees.
Case Summary & Role of Pre-operative Planning:
Planning this case pre-operatively with OrthoView enabled me to identify several key factors easily: the point at which to stop reaming (to avoid an intra-operative fracture), suitable stem sizes (diameter and length), as well as additional component sizes, the offset requirements for the stem, and the size of stem extension needed to obtain diaphyseal engagement. Digital preoperative planning also made it quick and easy to establish the mechanical alignment of the leg with the use of the SmartKnee Wizard.
Materialise OrthoView is a digital templating solution used by orthopaedic surgeons to create detailed pre-operative plans quickly and easily from digital x-ray images. Materialise OrthoView facilitates digital planning and templating for joint arthroplasty and revisions, trauma, limb deformity correction, osteotomy and spinal assessment and is chosen by hospitals worldwide to complete their target of film-free radiology.