by

Marc CLEMENS MD &

Yvan BARTHOLOME MD

by

Marc CLEMENS MD &

Yvan BARTHOLOME MD

Revision Knee ArthroplastyCLINICAL CASES

Revision Knee ArthroplastyCLINICAL CASES

LEGIONRevision Knee System

LEGIONRevision Knee System

Clinical Cases Clinical Cases

• 3 different problems• 3 different problems

• Learning time and complications• Learning time and complications

• Discussion• Discussion

• 3 clinical cases• 3 clinical cases

Clinical Cases Clinical Cases

• 1 - Allergy - Bone defect• 1 - Allergy - Bone defect

• 2 - Osteolysis • 2 - Osteolysis

• 3 - Classical TKA revisionPatellar sub-dislocation

• 3 - Classical TKA revisionPatellar sub-dislocation

• Clinical cases - 3 different problems• Clinical cases - 3 different problems

Case 1Case 1

Patellar fracturePatellar fracture

C. Simone C. Simone

• Woman - 71 years old

• Surgical past :

• Woman - 71 years old

• Surgical past :

Case 1Case 1

1998 Total Knee Arthroplasty(Nickel-Chrome-Cobalt)

1998 Total Knee Arthroplasty(Nickel-Chrome-Cobalt)

C. Simone C. Simone

• Woman - 71 years old

• Surgical past :

• Woman - 71 years old

• Surgical past :

Case 1Case 1

1998 - 2000 Allergy - Nickel !!!1998 - 2000 Allergy - Nickel !!!

C. Simone C. Simone

• Woman - 71 years old

• Surgical past :

• Woman - 71 years old

• Surgical past :

C. Simone C. Simone

• Woman - 71 years old

• Surgical past :

• Woman - 71 years old

• Surgical past :

Case 1Case 1

Year 2000 Femoral revisionGenesis II (Zirconium -3)

Year 2000 Femoral revisionGenesis II (Zirconium -3)

C. Simone C. Simone

• Woman - 71 years old

• Surgical past :

• Woman - 71 years old

• Surgical past :

Case 1Case 1

Year 2001

Release of the Lateral Patellar Retinaculum

(small sub-dislocation)

Year 2001

Release of the Lateral Patellar Retinaculum

(small sub-dislocation)

Case 1Case 1

2002 Cement “disease” +

Allergy +++

2002 Cement “disease” +

Allergy +++

C. Simone C. Simone

• Woman - 71 years old

• Surgical past :

• Woman - 71 years old

• Surgical past :

C. Simone C. Simone

• Woman - 71 years old

• Surgical past :

• Woman - 71 years old

• Surgical past :

Case 1Case 1

Year 2003

Tibial Revision(Full Poly - Size 15 - Max)

Dermatologist error !Allergy to Titanium

Year 2003

Tibial Revision(Full Poly - Size 15 - Max)

Dermatologist error !Allergy to Titanium

Case 1Case 1

Persistence of a large knee laxity+

Allergy

Persistence of a large knee laxity+

Allergy

C. Simone C. Simone

• Woman - 71 years old

• Surgical past :

• Woman - 71 years old

• Surgical past :

C. Simone C. Simone

• Woman - 71 years old

• Now :

• Woman - 71 years old

• Now :

Case 1Case 1

Year 2007

LEGION(Cement Simplex Antibiotic)

Year 2007

LEGION(Cement Simplex Antibiotic)

• Femoral implants:

Legion Oxinium size 4Stem 18 mm x 120 mmL-wedge 10 mm dist(x2) 10 mm post

• Patellar implant:

26 mm biconvex

• Femoral implants:

Legion Oxinium size 4Stem 18 mm x 120 mmL-wedge 10 mm dist(x2) 10 mm post

• Patellar implant:

26 mm biconvex

• Technical data• Technical data

• Tibial implants:

Legion baseplate size 36 mm offset couplerStem 22 mm x 120 mm

21 mm posterior stabilized articular insert

• Tibial implants:

Legion baseplate size 36 mm offset couplerStem 22 mm x 120 mm

21 mm posterior stabilized articular insert

Case 1Case 1

C. Simone C. Simone

C. Simone C. Simone

• Woman - 71 years old

• Post operative incident :

• Woman - 71 years old

• Post operative incident :

Case 1Case 1

Year 20071 week post-opLEGION

Fracture underthe TKA

Year 20071 week post-opLEGION

Fracture underthe TKA

Case 2Case 2

1975

Maquet

1975

Maquet

H. Lucienne H. Lucienne

• Woman - 73 years old

• Surgical past :

• Woman - 73 years old

• Surgical past :

Case 2Case 2

1979

Tibial Osteotomy

1979

Tibial Osteotomy

H. Lucienne H. Lucienne

• Woman - 73 years old

• Surgical past :

• Woman - 73 years old

• Surgical past :

Case 2Case 2

1987

Emslie

1987

Emslie

H. Lucienne H. Lucienne

• Woman - 73 years old

• Surgical past :

• Woman - 73 years old

• Surgical past :

Case 2Case 2

1990

Pseudarthosys of TTO

1990

Pseudarthosys of TTO

H. Lucienne H. Lucienne

• Woman - 73 years old

• Surgical past :

• Woman - 73 years old

• Surgical past :

Case 2Case 2

1992

Arthroscopy

1992

Arthroscopy

H. Lucienne H. Lucienne

• Woman - 73 years old

• Surgical past :

• Woman - 73 years old

• Surgical past :

Case 2Case 2

1993 Total Knee Arthroplasty

(Freeman - cemented femoral implant - uncemented tibial implant)

1993 Total Knee Arthroplasty

(Freeman - cemented femoral implant - uncemented tibial implant)

H. Lucienne H. Lucienne

• Woman - 73 years old

• Surgical past :

• Woman - 73 years old

• Surgical past :

Case 2Case 2

1994

TKA Revision

(Patella pain - femoral implant)

1994

TKA Revision

(Patella pain - femoral implant)

H. Lucienne H. Lucienne

• Woman - 73 years old

• Surgical past :

• Woman - 73 years old

• Surgical past :

Case 2Case 2

RecurvatumPainTibial osteolysis

RecurvatumPainTibial osteolysis

H. Lucienne H. Lucienne

• Woman - 73 years old

• Before our operation :

• Woman - 73 years old

• Before our operation :

Case 2Case 2

2007

TKA RevisionLegion - Offset

2007

TKA RevisionLegion - Offset

H. Lucienne H. Lucienne

• Woman - 73 years old

• Now :

• Woman - 73 years old

• Now :

• Femoral implants:

Legion Oxinium size 46 mm offset coupler Stem 15 mm x 160 mmL-wedge 15 dis x 5 posWedge 5 mm

• Patellar implant:29 mm biconvex

• Femoral implants:

Legion Oxinium size 46 mm offset coupler Stem 15 mm x 160 mmL-wedge 15 dis x 5 posWedge 5 mm

• Patellar implant:29 mm biconvex

• Technical data• Technical data

• Tibial implants:

Legion baseplate size 36 mm offset couplerStem 15 mm x 220 mm

15 mm posterior stabilized articular insert

• Tibial implants:

Legion baseplate size 36 mm offset couplerStem 15 mm x 220 mm

15 mm posterior stabilized articular insert

Case 2Case 2

H. LucienneH. Lucienne

Case 3Case 3

1991 Arthroscopy

1991 Arthroscopy

H. Albert H. Albert

• Man - 71 years old

• Surgical past :

• Man - 71 years old

• Surgical past :

Case 3Case 3

2002 Quadriceps tendon pulling up

2002 Quadriceps tendon pulling up

H. Albert H. Albert

• Man - 71 years old

• Surgical past :

• Man - 71 years old

• Surgical past :

Case 3Case 3

H. Albert H. Albert

• Man - 71 years old

• Surgical past :

• Man - 71 years old

• Surgical past :

2006 Total Knee Arthroplasty

(Tibial osteolysis, medial rotation, patellar sub-dislocation)

2006 Total Knee Arthroplasty

(Tibial osteolysis, medial rotation, patellar sub-dislocation)

Case 3Case 3

2007 TKA Revision

Legion

2007 TKA Revision

Legion

H. Albert H. Albert

• Man - 71 years old

• Now :

• Man - 71 years old

• Now :

• Femoral implants:

Legion Oxinium size 7Stem 18 mm x 160 mmL-wedge 10 dis x 5 posL-wedge 5 dis x 5 pos

• Patellar implant:

29 mm biconvex

• Femoral implants:

Legion Oxinium size 7Stem 18 mm x 160 mmL-wedge 10 dis x 5 posL-wedge 5 dis x 5 pos

• Patellar implant:

29 mm biconvex

• Technical data• Technical data

• Tibial implants:

Legion baseplate size 7Stem 16 mm x 160 mm

13 mm posterior stabilized articular insert

• Tibial implants:

Legion baseplate size 7Stem 16 mm x 160 mm

13 mm posterior stabilized articular insert

Case 3Case 3

H. AlbertH. Albert

For the tibial insert:

This revision system is based on an intramedullary guide.

Post scriptum : the anatomic axis approached the mechanicalaxis to within 1° on averagein both the anteroposterior and lateral planes.

For the tibial insert:

This revision system is based on an intramedullary guide.

Post scriptum : the anatomic axis approached the mechanicalaxis to within 1° on averagein both the anteroposterior and lateral planes.

Conclusion Conclusion

LEGIONRevision Knee System

LEGIONRevision Knee System

Bono JV, Roger DJ, Laskin RS, Peterson MGE,Paulsen CA. Tibial intramedullary alignment in total knee arthroplasty. 1998;13(2):241.

Bono JV, Roger DJ, Laskin RS, Peterson MGE,Paulsen CA. Tibial intramedullary alignment in total knee arthroplasty. 1998;13(2):241.

Thomas K. Fehring. Use of Stems in Revision Total Knee Arthroplasty. Revision Total Knee Arthroplasty. James V. Bono. Richard D. Scott Editors. 2005;13:137-144Thomas K. Fehring. Use of Stems in Revision Total Knee Arthroplasty. Revision Total Knee Arthroplasty. James V. Bono. Richard D. Scott Editors. 2005;13:137-144

It’s not like other revision knee systems where the direction of the tibial base plate restricted by the bone defects (+ grafts) determines the axis of the stem.

In such case, the use of long implants transfers stress from the deficient plateau to the shaft and might cause significant periarticular stress shielding.

It’s not like other revision knee systems where the direction of the tibial base plate restricted by the bone defects (+ grafts) determines the axis of the stem.

In such case, the use of long implants transfers stress from the deficient plateau to the shaft and might cause significant periarticular stress shielding.

Conclusion Conclusion

LEGIONRevision Knee System

LEGIONRevision Knee System

Diaphyseal engaging stemcausing malalignment ina tibia with valgus bowing.

Diaphyseal engaging stemcausing malalignment ina tibia with valgus bowing.

With the LEGION Revision Knee System,it’s necessary to have optimal length and width of stem to obtain a stable primary fixation.

To restore the anatomical axis of the tibial plateau; offset couplers, hemi-angled, hemi-stepped, full-angled or full-step wedges are available.

With the LEGION Revision Knee System,it’s necessary to have optimal length and width of stem to obtain a stable primary fixation.

To restore the anatomical axis of the tibial plateau; offset couplers, hemi-angled, hemi-stepped, full-angled or full-step wedges are available.

Conclusion Conclusion

LEGIONRevision Knee System

LEGIONRevision Knee System

This complex LEGION Revision Knee System allows the re-establishment of a balanced biomechanical knee arthroplasty and a favourable distribution of the stress shielding on the bone.

This complex LEGION Revision Knee System allows the re-establishment of a balanced biomechanical knee arthroplasty and a favourable distribution of the stress shielding on the bone.

Conclusion Conclusion

LEGIONRevision Knee System

LEGIONRevision Knee System

In practice :

Use preferably long stem

thansmall and large stem

to have a gooddistribution of loads

In practice :

Use preferably long stem

thansmall and large stem

to have a gooddistribution of loads

Conclusion Conclusion

LEGIONRevision Knee System

LEGIONRevision Knee System

• In case of :

press-fit stem and osteoporosys ofsmall bone cortical

take an implant 1 mm narrower than the last reamer size to avoid excessive constraints on bone structures.

• In case of :

press-fit stem and osteoporosys ofsmall bone cortical

take an implant 1 mm narrower than the last reamer size to avoid excessive constraints on bone structures.

Conclusion Conclusion

Reamer sizeReamer size

-1 mm-1 mm

14mm13mm11mm14mm

LEGIONRevision Knee System

LEGIONRevision Knee System

• When you have assembled the tibial base trial, the offset coupler and the stem,NEVER USE AHAMMER with thetibial baseplate impactorto insert the trial into the tibia.

• When you have assembled the tibial base trial, the offset coupler and the stem,NEVER USE AHAMMER with thetibial baseplate impactorto insert the trial into the tibia.

Conclusion Conclusion

XX

LEGIONRevision Knee System

LEGIONRevision Knee System

• USE the LONG STEM EXTRACTOR TOOL

and THE UNIVERSAL EXTRACTORto avoid compressing the trial J-hook system

and assess wrongly the correct length of the stem.

• USE the LONG STEM EXTRACTOR TOOL

and THE UNIVERSAL EXTRACTORto avoid compressing the trial J-hook system

and assess wrongly the correct length of the stem.

Conclusion Conclusion

LEGIONRevision Knee System

LEGIONRevision Knee System

• All these conclusions are particularly valid in case of :

- old patient- obesity

- osteoporosys- large bone defect

- tibial implant

• All these conclusions are particularly valid in case of :

- old patient- obesity

- osteoporosys- large bone defect

- tibial implant

Conclusion Conclusion

LEGIONRevision Knee System

LEGIONRevision Knee System

Thank You for your attentionThank You for your attention

LEGIONRevision Knee System

LEGIONRevision Knee System