最佳Total Knee播客 (2024)

1
Uni's 13:27

2+ y ago13:27

13:27

I am going to cover some of the things I consider when approaching Uni's Please take the time to leave a review and subscribe. Stay safe. Support the show

1
Suicide, Burnout, Mental Wellness 20:54

2+ y ago20:54

20:54

This is an important episode because we are all at risk. If you are in trouble or suffering ask for help, get help, seek help and ask for help again. If you see a colleague or friend who is having trouble ask how you can help and be sure to check in with them or seek help from your attending or other supervisors. Support the show…

1
TKA Specs - 100th Episode 33:22

2+ y ago33:22

33:22

This is the 100th Episode of the Total Knee Tips & Pearls Podcast Some techy stuff on TKA Recommended Distal Femoral Resections 8mm - Stryker Triathlon 9mm - DePuy Attune 9.5mm - Smith & Nephew 10mm - Zimmer Persona, DJO, Microport Anterior Flange Angle to Prevent Notching 3 degrees - S&N, Zimmer 5 degrees - DJO, DePuy 6 degrees - Microport 7 degre…

1
Essential Amino Acids after TKA 12:05

2+ y ago12:05

12:05

Two studies have shown that essential amino acids (EAA) can help function, and suppress atrophy of the rectus after TKA. Dreyer et al. J Clinc Invest. 2013;123(11):4654-4666. Essential amino acid supplementation in patients following total knee arthroplasty. Ueyama et al. The Bone & Joint Journal Vol 102-B, No. 6, Supp A. Perioperative essential am…

1
Acetabular Cups - Reaming and Liner Options 13:00

2+ y ago13:00

13:00

Do not take my word for it but do your research and verify everything. Here I'll review the four common cups many of us use Zimmer G7 - ream under by 1 mm, 36 mm ID options at 50 with 10 degree and +5 lat offset Stryker Trident II Tritanium - ream line to line, 36 neutral option at 48 and 36 mm options with lip and offset at 52 mm DePuy Pinnacle - …

1
Knee Arthroscopy 23:57

2+ y ago23:57

23:57

Here I share with some some tips and tricks on what I look for and what I do when caring for the 50 and older patient with knee pain that does not have severe arthritis and does have a meniscus tear. I also share some tips on what to do during boards collections to make sure you have copies of the intra-op photos and how I discuss the surgical find…

1
Hip Stems 24:16

2+ y ago24:16

24:16

Here is my take on the three new broach only collared hip stems Depuy Actis 130 degree neck shaft angle sizes 0-12 high offset 6mm (sizes 0-3) and 8 mm (sizes 4-12) Zimmer Avenier 135 neck shaft angle sizes 0-9 high offset 6mm collared and non-collared options coxa vara neck 126.5 degrees Stryker Insignia 130 degress neck shaft angle sizes 0-11 hig…

1
Talking to patients about Leg Length Discrepancy 15:03

3y ago15:03

15:03

LLD is a real issue. Here I will go over a number of things that can cause or lead to a LLD. I will share things I look for and how I talk to patients about LLD and what things you can do at the time of surgery to control for LLD. Support the show由Dr. Adam Rosen

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Fellowship - What to look for 16:38

3y ago16:38

16:38

What you are looking for in a fellowship is a personal decision. I covered this topic before but we are in the middle of fellowship applications and most applicants have the same questions. Here I discuss volume, autonomy, approaches, implants, technology, clinic, revisions and finding a job. Support the show…

1
Robotics or Lack There Of - You still need training in manual total knees 16:26

3y ago16:26

16:26

I used nav in 2005 and was looking forward to robotics when they came on the scene. First it was Mako and now Rosa and Velys. Unfortunately, the powers that be have not allowed them in our system yet. I think it is important for residents and fellows to be trained with robots. It is a part of education today. Robotic training will help you land a j…

1
Augmented Reality 10:54

3y ago10:54

10:54

AR is something I am really excited about. Here is my two cents on the future of AR technology in total knees Support the show由Dr. Adam Rosen

1
The Knee Book - A Guide to the Aging Knee 10:20

3y ago10:20

10:20

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…

1
Pre-Flight Checklist 16:56

3y ago16:56

16:56

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…

1
Cement Technique for Hemi's & THA 11:53

3y ago11:53

11:53

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 Support the show由Dr. Adam Rosen

1
Biofilmology 13:34

3y ago13:34

13:34

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 thi…

1
Valgus Knees 16:16

3y ago16:16

16:16

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 Support the show…

1
Dr. Colwell Interview #2 1:03:03

3y ago1:03:03

1:03:03

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 Support the show…

1
Varus Knees 18:46

3y ago18:46

18:46

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 - V…

1
Interview with Dr. Colwell 1:00:27

3y ago1:00:27

1:00:27

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 c…

1
Optimize your patient 22:36

3+ y ago22:36

22:36

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. Estima…

1
Hip Balancing 24:46

3+ y ago24:46

24:46

I find this topic a more difficult topic to teach than knee balancing. Everything is important to get a stable hip. You need a good approach, pre-op planning, implant positioning and the restoration of length and offset. You need to be aware of balancing and how to address anatomic on anatomic impingement, implant on anatomic and implant on implant…

1
Tips for Hemi's 8:50

3+ y ago8:50

8:50

These two tips can be used when performing a hemiarthroplasty for a hip fracture. You may also consider it even if doing a THA for a fracture or a THA for arthritis in certain patients such as parkinson's disease. Check out my other episode on a more detailed explanation of how I do my posterior approach to the hip. - https://www.buzzsprout.com/725…

1
Reading an X-ray 13:52

3+ y ago13:52

13:52

Its good to have an algorithm that works for you when describing an x-ray. Here I will go through my thought process to make sure that you cover everything and not miss things. Support the show由Dr. Adam Rosen

1
The PFJ in TKA (#79) 11:22

3+ y ago11:22

11:22

The kinematics of the knee are so complex. You can not overlook the PFJ. We are taught early on about medializing the button and lateralize the femur and make sure your femoral rotation is correct. If not you are taught to do a lateral release. The balancing of the PFJ is so important. Overstuff it and you have pain and limited range of motion. Too…

1
A Comparison of Four Models of Total Knee Replacement Prostheses 18:59

3+ y ago18:59

18:59

A Comparison of Four Models of Total Knee Replacement Prostheses John Insall, Chitranjan Ranawat, Paolo Aglietti, John Shine JBJS 1976 Support the show

1
Merchant View 4:48

3+ y ago4:48

4:48

Roentgenographic Analysis of Patellofemoral Congruence Alan Merchant, Richard Mercer, Richard Jacobsen, Charles Cool JBJS 1974 Merchant View - patient is supine on the x-ray table. The knees are flexed 45 degrees and the legs are strapped. The beam to femur angle is 30 degrees and the plate is positioned against the shins. Sulcus Angle of Brattstro…

1
Rosenberg View 7:32

3+ y ago7:32

7:32

The Forty-five-Degree Posteroanterior Flexion Weight-Bearing Radiograph of the Knee Thomas Rosenberg, Lonnie Paulos, Richard Parker, David Coward, Steven Scott JBJS 1988 PA x-ray with the knee in 45 degrees of flexion and the patella touching the cassette. The beam is aimed at the inferior pole of the patella and aimed 10 degrees caudad, 55 patient…

1
Hip Stability - Dorr 35:07

3+ y ago35:07

35:07

Current Concepts Review Impingement with Total Hip Replacement JBJB 2007 Aamer Malik, MD, Aditya Maheshwari, MD, and Lawrence Dorr, MD For hip stability: Evaluate the x-rays and template Be wary of hypermobile patients and spine patients Know your implants (head options, neck options, etc) Check patients supine and again lateral (for posterior appr…

1
ORDERS - ADCVAANDIMLS 15:23

3+ y ago15:23

15:23

Hopefully your system does not go down but when it does here is your cheat sheet. 1. ALWAYS DATE AND TIME 2. SIGN and print your name and/or doctor number, pager number, etc 3. Make sure the patients name and medical record number or DOB is on the page A- Admit D - Diagnosis C - Condition and Code Status V - Vitals A - Allergies A - Activity N- Nur…

1
DeLee and Charnley 9:07

3+ y ago9:07

9:07

Radiological Demarcation of Cemented Sockets in Total Hip Replacement Jesse DeLee and John Charnley CORR 1976 3 Types/Zones Zone 1 - Superior lateral Zone 2 - Central or Medial Zone 3 - Inferior medial Support the show由Dr. Adam Rosen

1
Singh Index and Ward's Triangle 9:20

3+ y ago9:20

9:20

Changes in Trabecular Pattern of the Upper End of the Femur as an Index of Osteoporosis Manmohan Singh et al JBJS 1970 Grade 6 - All normal trabeculae are visible Grade 5 - accentuation of the principal compressive and principal tensile trabeculae - Ward's triangle looks empty Grade 4 - tensile trabeculae are reduced - Ward's triangle opens up late…

1
Crowe Classification 10:02

3+ y ago10:02

10:02

Total Hip Replacement in Congenital Dislocation and Dysplasia of the Hip John Crowe, John Mani, Chitranjan Ranawat JBJS 1979 I - < 50% subluxation II - 50% - 75% subluxation III - 75% - 100% subluxation IV - >100% subluxation Support the show由Dr. Adam Rosen

1
ICM 2018 Criteria for PJI 8:58

3+ y ago8:58

8:58

The International Consensus Meeting on MSK Infection presented their new criteria in 2018 Major Criteria 1. Two positive periprosthetic cultures w/ phenotypically identical organisms 2. A sinus tract communicating with the joint ____________________ Minor Criteria > or equal to 6 = infected 4-5 = inconclusive < or equal to 3 = not infected ________…

1
Kellgren-Lawrence Classification 10:46

3+ y ago10:46

10:46

Kellgren, Lawrence. Radiological Assessment of Osteoarthritis. Ann Rheum Dis. 1957;16:494-502 Grade 0 - No presence of OA Grade 1 - Doubtful narrowing, possible osteophytes Grade 2 - Possible narrowing, definite osteophytes Grade 3 - Definite narrowing, moderate osteophytes, some sclerosis and possible deformity Grade 4 - severe narrowing, large os…

1
Paprosky Classification of femoral bone loss 7:55

4y ago7:55

7:55

Paprosky Classification of Femoral Bone Loss Type I - minimal metaphyseal bone loss Type II - extensive metaphyseal bone loss, minimal diaphyseal bone loss Type IIIA - extensive metaphyseal and diaphyseal bone loss with greater or equal to 4 cm intact diaphysis for "scratch fit" Type IIIB - extensive metaphyseal and diaphyseal bone loss with less t…

1
Gruen and Modes of Failure 9:39

4y ago9:39

9:39

"Modes of Failure" of Cemented Stem-type Femoral Components Gruen, McNeice and Amstutz CORR 1979 Seven Gruen zones 1 - proximal lateral 1/3 2 - central lateral 1/3 3 - distal lateral 1/3 4 - tip 5 - distal medial 1/3 6 - central medial 1/3 7 - proximal medial 1/3 Modes of Failure I. Pistoning Ia. stem pistons in cement (punch-out crack) Ib. cement …

1
The Future of TKA's with AI 15:03

4y ago15:03

15:03

I just wanted to share my thoughts and give you my two cents on where we may be in ten years. We still have 20% of patients that are dissatisfied after TKA. WHY? We get answers from industry - nav and robots? But, what is the question? Listen in to hear my thoughts on AR and AI and how a heads up display could help you decide how to best perform a …

1
Garden and Pauwels 16:37

4y ago16:37

16:37

Low-Angle Fixation in Fractures of the Femoral Neck Garden JBJS-B 1961 Stage I - Incomplete and abducted or valgus impacted Stage II - Complete and non-displaced Stage III - Complete partially displaced Stage IV - Complete fully displaced Pauwels Classification 1935 I - up to 30 degrees II - 30 - 50 degrees III - greater than 50 degrees a line draw…

1
AORI 11:53

4y ago11:53

11:53

AORI Classification Type 1 - Minimal bone defect, intact metaphysis - Treat with cement or impaction grafting Type 2A - Metaphyseal bone damage of 1 femoral condyle (F2A) or 1 half of the tibial plateau (T2A); posterior condyles are reduced - Treat with cement, augments, bone graft, cones/sleeves Type 2B - Metaphyseal bone damage of bone femoral co…

1
Dorr Classification 5:59

4y ago5:59

5:59

Dorr Classification; Bone 1993 "Structural and Cellular Assessment of Bone Quality of Proximal Femur" A - Thick cortex - champagne flute canal B - Thin cortex with residual funnel shape C - Thin cortex - "stove pipe canal" Canal/Canal Ratio A - <0.5 B - 0.5 - 0.75 C - >0.75 Support the show由Dr. Adam Rosen

1
Cement Grading 8:53

4y ago8:53

8:53

Barrack & Harris JBJS-Br 1992 "Improved Cementing Techniques and Femoral Component Loosening in Young Patients with Hip Arthroplasty. A 12 Year Radiographic Review." A - Complete fill, the classic "White Out" B - slight radiolucency C - radiolucencies 50% - 99% D - complete radiolucent line 100% and/or failure to cement the tip of the stem Support …

1
Vancouver Classification 6:57

4y ago6:57

6:57

Vancouver Classification by Duncan and Masri ICL 1995 Treatment options added in CORR 2004 Type A AL - lesser trochanter - non-op unless larger medial piece AG - greater trochanter - non-op unless >2.5 cm displacement Type B B1 - well fixed stem - ORIF B2 - loose stem, adequate bone stock - revision w/ ORIF B3 - loose stem poor bone stock - revisio…

1
Osteonecrosis Staging Systems 9:07

4y ago9:07

9:07

Here I review the two common classifications for ON of the hip, Ficat and Steinberg. The modified Ficat, Idiopathic bone necrosis of the femoral head, was published in 1985 JBJS-Br 0 - Preclinical and pre-radiographic I - Xray is normal but hip is symptomatic II - sclerosis and cysts on xray III - Crescent sign IV - OA with a deformed head Steinber…

1
Fairbank 5:55

4y ago5:55

5:55

Knee Joint Changes after Meniscectomy by T.J. Fairbank published JBJS - Br 1948 The following radiological changes were seen after meniscectomy 1. Ridge formation 2. Narrowing of the joint space 3. Flattening of the femoral condyle Support the show由Dr. Adam Rosen

1
HO - Brooker Classification 4:42

4y ago4:42

4:42

Brooker et al JBJS Vol 55-A 1973 Class I - Islands of bone within the soft tissue around the hip Class II - Bone spurs from the pelvis or proximal femur , leaving at least 1 cm between Class III - Bone spurs from the pelvis or proximal femur, reducing the space between to less than 1 cm Class IV - bony ankylosis Support the show…

1
Patella Clunk 6:28

4y ago6:28

6:28

Although rarely seen with newer TKA designs this was a diagnosis seen in patients with TKAs and could be extremely symptomatic. Patellar clunk was first described by Hozack et al in 1989. Patellar clunk occurred when a fibrous nodule forms above the patella. This nodule would get caught in the intercondylar notch in flexion and then cause a painful…

1
The Outerbridge Classification 7:14

4y ago7:14

7:14

This is the first in a series of episodes where I review some classic articles and classifications. The Outerbridge classification was first presented in JBJS-B in 1961 The classification is as follows: 1 - Softening and swelling 2 - Fragmentation and fissuring less than 1/2 inch diameter 3 - Fragmentation and fissuring greater than 1/2 inch diamet…

1
Using a Star System for Difficult Cases 6:59

4y ago6:59

6:59

In my first year of practice I remember a day where I only had three joints but it took all day and I was exhausted. Although they were all primaries they each had a component that made them hard - size, bone loss, stiffness. I created a system that allowed me to communicate with my scheduler so they could spread out the hard cases which prevented …

1
Balancing Algorithm in TKA 27:13

4y ago27:13

27:13

Most gunners, interns and residents have memorized "the chart." That chart with what to do in a TKA when flexion is loose or the extension gap is tight or vice versa. Here I want to review that and more and discuss the things that I look for during balancing. Support the show由Dr. Adam Rosen

1
Consults for the Non-Orthopedic Specialists 26:09

4y ago26:09

26:09

Ortho is consulted for many things. Here I would like to go over a few topics. First, for most ortho consults we need an x-ray. For a fracture or dislocation it is imperative. Even without trauma a bone can break if it had an un-diagnosed tumor. Even when the xray is normal, the information is important. I will discuss compartment syndrome, celluli…

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