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Anatomical landmarks and prerequisite for mistakes in TKA

K. Mihov, A. Tabakov, M. Zagorov, S. Dobrilov


Total knee replacement (TKR) is the gold standard in treatment of end stage knee arthritis, aiming pain relief, restore of the range of motion and improved function. Despite the fact that the patient satisfaction rate is reported up to 90%, revision surgery is still required in some cases. This is why preoperative clinical evaluation, indications, contraindications, radiographic analysis, type of implant and surgical technique are essential for the TKA and can affect patient`s outcome.Radiographic and intraoperative anatomical landmarks are playing an important role for achieving accurate prosthetic seating, axial alignment and range of motion. The full-leg (AP) weight bearing X-ray gives the surgeon information about the anatomical and mechanical axis of the leg, knee joint angles and Q-angle. The lateral (ML) view gives information about Insall-Salvati Ratio, posterior condylar offset, posterior tibial slope and knee joint level. Femoral sulcus, posterior cruciate ligament insertion, tuberositas tibiae, tibial crest, posterior femoral condylar line, transepicondylar line and Whitesides` line are some of the intraoperative landmarks that helps the surgeon to implant the prosthesis more accurate and to reproduce the knee kinematic.Accurate pre-operative templating lowers the operative time, complication rate and health care costs. The orthopedic surgeon needs to understand the basic principles and nuances and to be enough experienced and skilled to reproduce them.



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About The Authors

K. Mihov

A. Tabakov

M. Zagorov

S. Dobrilov

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