TC3 Femoral Component is available in seven sizes. • Modular Femoral Stem, known as the SIGMA Femoral. Adapter, which allows the use of the Femoral. seven sizes. • TC3 Femoral Component available in six sizes DePuy Orthopaedics EMEA is a trading division of DePuy International Limited. Registered. TC3 Femoral Component is available in six sizes. · Modular Femoral Stem, known as the SIGMA Femoral. Adapter, which allows the use of the Universal.
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The SIGMA® TC3 design is a semi-constrained device available within the SIGMA Knee System. It is indicated for use in cases where the lateral collateral. I use the DePuy Revision Knee System because of its versatility. With SIGMA® TC3 RP has been shown to reduce torque stresses by up to 87% versus a. Compatible with P.F.C. Sigma CS and TC3 femoral components. • P.F.C. Sigma Femoral .. For more information about DePuy products, visit our website at.
References this series are non-modular in terms of keel and tray such that the 1. Future young patient demand for primary and revision sleeve mates with the tibial tray via Morse taper.
This is not the case joint replacement: national projections from to Clin Orthop Relat Res ; Bone loss with revision total knee arthroplasty: defect mate to the sleeve. Instr Course Lect ; Impaction grafting for bone defects in revision total knee arthroplasty. The decision to use a metaphyseal sleeve construct was made at 4.
Bradley GW. Revision total knee arthroplasty by impaction bone grafting. Ries MD. Impacted cancellous autograft for contained bone defects in total knee arthroplasty. Am J Knee Surg ; The use of structural allograft for larger defects are present. That is not to say that these defects could uncontained defects in revision total knee arthroplasty.
J Bone Joint Surg Am ; Use of structural allograft in revision total knee arthroplasty in knees with severe tibial bone loss. Limitations of the study include the lack of a control group as well 8. Technique and results of allograft reconstruction as the non-randomized patient selection and relatively short follow- in revision total knee arthroplasty.
Also, of the 51 patients originally enrolled, six were lost to follow- 9. Reconstruction of massive bone defects with allograft in revision total knee arthroplasty. Management of bone loss: structural grafts in revision follow-up, we were able to obtain survivability information on 40 of total knee arthroplasty.
Revision Total Knee Arthroplasty with Metaphyseal Sleeves without Stem: Short-Term Results
The structural allograft composite in revision total knee arthroplasty. J Arthroplasty ;17 4 Suppl 1 Our study adds to other limited published data regarding the use of Treatment of nonunions about the knee metaphyseal sleeves for tibial defect management in revision TKA. J Three studies in the literature report clinical outcomes after the use of Arthroplasty ; The kinematic rotation hinge prosthesis for metaphyseal sleeves.
Jones et al performed revision TKA utilizing complex knee arthroplasty. Management of bone loss: augments, sleeves, offset stems. Cementless metaphyseal sleeves used the sleeve because data could be confounded by their inclusion of for large tibial defects in revision total knee arthroplasty. J Arthroplasty ; patients with cemented tibial stems. Two studies previously pub- The fate of augments to treat type 2 bone defects was a study performed by Jones et al who looked at 15 patients in revision knee arthroplasty.
Modular tibial augmentation in total knee treated with S-ROM mobile bearing hinged implants with metaphy- arthroplasty. Clin Ortho Relat Res ; Roentgenographic assessment of the biological Society scores and saw no evidence of loosening.
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Clin Orthop Relat Res ; was conducted by Alexander et al who looked at the use of Prevalence of primary and revision total hip and knee arthroplasty in the United States from through Furthermore many studies report that an important theoretical disadvantage is the reduction of post-operative motion.
However they concluded that between the PS and CCK groups with regard to postoperative outcome the total arc of motion, passive extension, and passive flexion were all similar between groups. With introduction of the second generation prosthesis, now in use, the rate of patellar complications and the need of lateral retinacular release decreased sensibly 6.
Our experience shows good clinical outcome and patient satisfaction after primary knee replacement with CCK prosthesis.
Depuy tc3 technique guide
We always intraoperatively evaluated articular surface degeneration of the patella and every time we could, we performed patella resurfacing. We did not point out important complications related to patellofemoral joint and to extensor mechanism in general. No fractures or necrosis of the patella was reported.
Several works described aseptic loosening of the components due to polyethylene wear, but other studies with mid-term and long term follow-up showed good results: Lachiewicz 27 knees 6 and Cholewinski et al.
Maynard shows that radiolucent lines were found in 9. They were not progressive and likely suggest incomplete cement pressurization According to literature we did not find any loosening in our series Jamsen with a register-based analysis of 43, cases shows several risk factors for infection after TKA and a correlation with type of prosthesis is clear.
In this paper there was a trend showing an increased rate of infection in association with constrained and hinged prostheses in comparison with non-constrained devices, and the trend was statistically significant only for primary arthroplasties, not for revisions. However a low rate of infection is shown with a percentage of 1.
Use of femoral and tibial stems is controversial and recently on modular constrained knee system have been developed. This constrained condylar component has offered solutions to end of stem pain, canal invasion, complicated revision, and the high cost associated with diaphyseal stem extensions Traditionally, CCK are used with stems to transfer load to the intramedullary canal and unload the bony interfaces but several papers show that is possible to use implant without femoral stem only when femoral bone is not deficient and well preserved for femoral implant support.
If there is inadequate bone on the femoral side, a stem should be used routinely. Obviously in case of revision, stems are difficult to remove, especially if cemented, and this could cause an additional bone loss. Stems positioning lengthens surgical time and can eventually cause diaphyseal fractures Anderson et al.
We always decided to apply femoral and tibial stems as suggested by surgical techniques of the chosen implants. We used also metal sleeves in four cases with an important osteoporotic disease always with TC3 DePuy prosthesis. We did not experience any diaphyseal fracture during our series.
In three cases patients suffered of thigh pain in the immediate post operatory, probably related with femoral stem. Pain resolved with magnetic field treatment after 3—4 months, without sequelae. Mean KSS improvement after surgery was similar to other previous studies Mean postoperative ROM was All knees had reach complete extension at last follow-up. In addition, we should keep it in mind that the simulation did not consider, due to technical impossibility, loads in more extreme values with the varus deformity, namely in agricultural labor.
The same can be said of tibial periprosthetic bone fractures 9. Scott et al 4 postulated that the varus implantation of the tibial component of a total knee arthroplasty increases the concentration of loads with their asymmetric distribution, and can cause a metal fatigue fracture. Also the implantation of the tibial component in external rotation was identified as responsible for excessive loads in tibial components, specifically in total condylar III knee 10 arthroplasties, as well as in the polyethylene fitting zone 5,11, The work of Maquet 13 demonstrated that, in the static position, varus knee deformity produces the exponential growth of loads transmitted to the medial tibial plate, not only through the increase of the lever arm but also through the decrease of the load-bearing surface.
However, Johnson et al 14 and Harrington 15 report that this increase is mainly in the orthostatic position, since during gait, there is a passage of the load-bearing surface to the medial zone, and, as such, the load increase is not as intense. The simulations with finite element models showed that a varus deformity increases stress values in the medial tibial plate 1.
In this case, we went on to study the patient's local conditions, paying attention to bone mass, weight and height of the patient as well as the type of arthroplasty implanted through the finite element method.
Analysis by the finite element method is an engineering tool whose use is becoming increasingly frequent in the calculation and design of implants and that can become important in cases such as the one described here, as it allows us to simulate the local conditions of implantation of an arthroplasty, contributing to the understanding of possible causes of failure or mistakes committed.
The tests showed that the zones of greatest stress are concordant with the alterations observed in the prosthesis removed from the patient, although the maximum load peak was lower than the fatigue limits of the material indicated by the manufacturer, both in the correct position and in the position presented in the patient's initial assessment.
However, it should be noted that the maximum peak of stress doubled from one position to the other, which leaves open the possibility that the patient may have reached the fatigue limits, since she was an agricultural laborer and this work entails intense efforts, and above all, very heavy loads and objects for transportation sometimes between 50 and kg.
In the radiograph obtained upon admission to our hospital, it is not possible to identify poor initial alignment, and we were unable to obtain the immediate postoperative radiograph, but we believe that the varus positioning of the tibial component is secondary to the fracture that will have occurred first and was not identified.
Since the patient continued to work and only noticed progressive varus deformity, the bone collapse may have permitted the varus positioning found on the date of admission to our unit, and, taking into account the patient's type of work, the repeated loads changed significantly, having possibly arrived at or even surpassed the fatigue limit of the titanium alloy, secondarily provoking a fatigue fracture of the material. Although the cause of a potential fracture risk cannot be attributed to the design of the arthroplasty, this case alerted our attention to this possibility in extreme situations such as the one described here, and was the basis of our decision not to use monoblock tibial plate having abandoned the modular option.
Breakage of the metal tray in total knee replacement.
Fracture of the metal tibial tray after Kinematic total knee replacement. A common cause of early aseptic failure.
J Bone Joint Surg Br. Classification of periprosthetic tibial fractures. Surgical techniques in total knee arthroplasty.
New York: Springer-Verlag; Fracture of the metallic tibial tray following total knee replacement. Report of two cases.
J Bone Joint Surg Am. Fracture of the tibial tray of the PCA knee.
A case report of early failure caused by improper design. Acta Orthop Scand. The forces in the distal femur and the knee during walking and other activities measured by telemetry.
J Arthroplasty. Estimation of material properties in the equine metacarpus with use of quantitative computed tomography.Porous tantalum cones are effectively used for management of bone loss, but they have two interfaces, one with bone and one with implant, and this may be a weak link of the implant.
It is helpful to palpate the distal femoral shaft as the drill is advanced. With the broach seated in the femur, attach the Threaded Shaft to the broach Figure Traditionally, CCK are used with stems to transfer load to the intramedullary canal and unload the bony interfaces but several papers show that is possible to use implant without femoral stem only when femoral bone is not deficient and well preserved for femoral implant support.
Post-operative care is extremely important.
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