Total Knee Tips & Pearls From Dr. Adam Rosen (A Virtual Total Knee Fellowship Podcast)

AR is something I am really excited about. Here is my two cents on the future of AR technology in total knees

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I am happy to share my new book THE KNEE BOOK - A GUIDE TO THE AGING KNEE

It was written for patients and it is written to patients in easy to understand language.

The book is a perfect recommendation for patients with knee pain that have questions.

I believe it is also a great resource for residents and young surgeons. In it I review the algorithm for treating patients with knee pain from the most conservative up to knee replacement.

What I think is the best benefit for young surgeons is all of the analogies I use to explain things to my patients. You can pick these up by reading the book so that you can better explain things to your patients.

It is also a great read for non-orthopedic doctors, PA's or NP's. Anyone that treats knee pain patients. It explains why we need weight bearing x-rays and not MRI's and more.

You can download the ebook at Amazon here:
https://www.amazon.com/Knee-Book-Guide-Aging-ebook/dp/B09NLL58LG/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=1639946441&sr=8-2

You can get the paperback here:
https://www.amazon.com/Knee-Book-Guide-Aging/dp/B09NKWMYFN/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1639946441&sr=8-2

Available at Barnes and Noble as a Nook here:
https://www.barnesandnoble.com/w/the-knee-book-a-guide-to-the-aging-knee-adam-rosen/1140795276?ean=2940161052846

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I still do this every Friday (sooner if it is a complicated revision)
Check the patient, age, BMI, nasal swab, dvt proph. Check the x-rays and make sure the implants are ordered. Review the labs and any clearances that are needed.

Double check everything necessary with the patient the day of surgery.

Make sure the room is set up with everything you need prior to the patient coming into the room.

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Whether you are doing a hemi or total, cementing the femoral component takes some skill. Here I will share with you my tips on how to get a good cement mantle.

A link to the episode on cement grading:

https://www.buzzsprout.com/725061/episodes/7501843

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SSI is the number one reason for unplanned admission after TJA.

Biofilm can form within minutes and be mature within 24 hours. Biofilm contains approximately 80% ECM and 20% bacteria.

Check out this lecture by Next Science that was given at AAOS 2021

https://www.youtube.com/watch?v=5WPZ02t8hEs&list=PL226EPMMG9vYS9F1oDCU9SvOOBIqjJXze&index=6

And this two part series:

https://www.youtube.com/watch?v=cG3iOT4vZlA&list=PL226EPMMG9vYWosH11BTZh1_2g02R-M92&index=7&t=31s

https://www.youtube.com/watch?v=ZDXZFbCEilw&list=PL226EPMMG9vYWosH11BTZh1_2g02R-M92&index=8

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I discussed varus knees previously, here is my two cents on what I look for and how I approach the valgus deformity when performing a TKA

Krackow
I - min valgus
II - deformity > 10 degree, medial soft tissue stretching
III - severe, incompetent medial soft tissues, have constrained/hinge avail

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I had the chance to sit down for the second time with Dr. Colwell. In this episode we cover teaching fellows, running two rooms, bilateral total joints and more.

If you haven't listen to the first episode you can listen here:

https://podcasts.apple.com/us/podcast/interview-with-dr-colwell/id1507691532?i=1000536512016

Listen on: Apple Podcasts   Spotify

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Know if it is fixed or correctable
Assess the amount of osteophytes
Release MCL around to semimembranous
Assess PCL if using CR
Consider downsizing tibial and removing additional medial bone

Further Reading:

Master Techniques Knee Arthroplasty - Lotke and Lonner
Chapter 7 by Scuderi and Insall

Advanced Reconstruction of the Knee AAOS
Chapter 27 - Varus Knee - Windsor and Choi

JAAOS Article Dr. Mihalko -  http://upload.orthobullets.com/journalclub/free_pdf/19948701_19948701.pdf

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I first met Dr. Colwell when I came west to interview for a fellowship at Scripps Clinic. I had the pleasure to sit down and ask him some questions about orthopedics and his career. We talked for an hour and a half and I could have spent all day listening to his stories. We didn't have time to get to every question that I had for him so I hope we can sit down again soon for a second Dr. Colwell interview.

Listen on: Apple Podcasts   Spotify

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References:
Ng et al. Preoperative Risk Stratification and Risk Reduction for Total Joint Reconstruction. AAOS 2013
Aram et al. Estimating an Individual's Probability of Revision Surgery After Knee Replacement. Am J of Epid 2018
Gronbeck et at. Risk stratification in primary total joint arthroplasty. Arthroplasty Today 2019
Florschutz et al. Estimating patient specific mortality after joint replacement. Osteoarthritis and Cartilage 2019
Ziebma-Davis et al. Outpatient Joint Arthroplasty. J Arthoplasty 2019
National Joint Registry online Risk Assessment tool. jointcalc.shef.ac.uk

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