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

The dreaded hip dislocation is a complication we all want to avoid.  Balancing is very important.  Here I discuss my steps for checking stability in every patient every time.
1. leg length
2. combined Ranawat sign
3. Extension
4. Extension and external rotation
5. Position of sleep
6. Full flexion
7. Flexion, adduction and internal rotation

This sequence helps me look for osteophytes that can be a source of impingement and instability.  It allows me to determine if I need to make a change in the cup position, stem position, offset or length.

https://www.DrAdamRosen.com

Support the show

Patients present with painful total knees and the diagnosis is not always easy.  Here I will talk about what I do in my workup of these patients.  I go back to before surgery and get early xrays and listen to what conservative treatments they have had.  A detailed peri-operative history and any complications is important.  Labs, aspirations and special tests all have a role.  The differential is large and you have to have a good plan an algorithm to go through all of the potential causes of pain.

Listen on: Apple Podcasts   Spotify

Support the show

Restoring the joint line is the most important part of a total knee revision in my opinion.  Restoring the JL in any total knee is important but it is most difficult to re-create in a revision due to the bone loss.  Here I review my experiences and tips on what I do to restore the JL to the appropriate position.

https://www.DrAdamRosen.com

Support the show

I have had the idea of creating a podcast for quite some time and it has been a really interesting learning experience for me. I am grateful for all of the listeners and subscribers.  My hope has always been to share my thoughts and tips in an attempt to give you one tip or tool that allows you to help one patient obtain a better outcome.

In this last episode of Season one I just wanted to review briefly what we have talked about but reiterate some important pearls.  My plan for season two is to talk about revisions, the workup of the painful total knee, infections, periprosthetic fractures and more.

Once again, thanks for listening and stay safe.

Support the show

In training we focus on the procedure.  Unfortunately, some do not get enough exposure with the post-operative patient care issues.  Here I will discuss some common things I see, how I educate my patients and what things to watch out for at both the one month and three month follow-up appointments.

Support the show

Stiffness after TKA can be a big problem.  The goal is to not develop stiffness and this begins with preoperative education, a technically well done TKA and appropriate post-op PT.  Still, some patients may get stiff.  Your goal is to capture those patients early so that there is still time to make a difference.  Otherwise a MUA may be needed.  Here I will share things that I have seen and tips that I have used to keep my rate of stiffness and need for MUA low.

Support the show

The surgery is just one part of obtaining a good total knee outcome.  The patient and their participation in post-operative PT is just as important to obtain a good outcome.  A good total knee needs good range of motion and strength that will result in a well functioning total knee.  Here I will discuss some of the tips I have used with my patients, and the reasons behind them, which have resulted in good outcomes and good range of motion.

Support the show

Pain control following a total knee is an art and a science.  The idea of multimodal non-narcotic scheduled medication is a great improvement over the old way of treating pain.  Here I will review my philosophy and algorithm for treating pain symptoms related to total knee replacement surgery.

Support the show

Here I will give you a full audio walk thru of a typical TKA from draping to closure.  Although previous episodes have gone into more detail of each individual part of the operation, this episode will take you through the procedure with a focus on knee position and retractor position from start to finish.  This should hopefully build on what you have listened to in previous episodes.

Again, I do not believe that this is the best or only way to do a TKA but it is a step-wise pattern that works well for me.

Listen on: Apple Podcasts   Spotify

Support the show

I believe that these are all important so I wanted to re-review some important operative tips.  I will review ways that you could potentially alter the alignment during the procedure.  We will also go over ways to control the saw and decrease potential contamination and infection.  Lastly, I will go over ways to be more efficient.  Remember: slow is smooth and smooth is fast.  Having a plan, working with teams and being purposeful can make you a more efficient surgeon.

Support the show