|
Year |
2004 |
|---|---|
|
Question Number |
182 |
|
Category |
Hip and Knee Reconstruction |
Question
During revision total knee arthroplasty with the trial components in place, the knee is tight in extension and loose in flexion. Correction involves which of the following changes?
1. Use of a thinner tibial polyethylene insert
2. Use of a thinner distal femoral augmentation wedge
3. Use of a smaller femoral component
4. Resection of more proximal tibia
5. Shifting the femoral component anteriorly with an offset stem
Figures
Answer (click for answer)
Gap balancing is a relatively extensive topic, so I?ll try to focus on this question in particular. The listed resource for this question is a pretty decent article out of JBJS May ?03. The article contains a good table that is probably worth looking at. The basic idea with this question is that your main option is to resect more distal femur and use a thicker tibial insert until balanced. The correct answer is the one most similar to this option. That is, using a thinner distal femoral augmentation wedge is similar to resecting more distal femur.
Reference: Ries MD, Haas SB, Windsor RE: Soft-tissue balance in revision total knee arthroplasty. JBJS Am 2003;85:538-542.