Total knee replacement (posterior stabilised): Visionaire Genesis II (Smith and Nephew) surgical technique
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This case illustrates the use of patient specific instrumentation to perform a total knee replacement. The Visionaire technology is from Smith & Nephew, being introduced in 2010. It utilises a single weight bearing AP alignment film of the patient’s leg and a focused MRI of their knee to provide the data for cutting jig and implant design. The information is relayed to technicians who are based in the United States of America who design the knee replacement for you within the parameters you have set for them.
The surgeon sets the sizing constraints for example to upsize unless medial-lateral overhang, the rotational axis, the varus/valgus alignment, the tibial slope and tibial rotation. These usually correspond to the the typical component features used in a standard knee replacement, but can be varied.
Once the implant has been designed the plan is e-mailed to the surgeon and it is then checked and accepted. Printed 3-D printed nylon cutting blocks are manufactured for both the tibial and femoral sides of the knee replacement. The blocks are applied to the patient intra-operatively, cuts made and then the final preparation of the bone is performed using standard instrumentation and the total knee replacement is then implanted.
The use of Visionaire technology is associated with more reproducible implant placement, decreased operative times, fewer equipment trays in theatre, a reduced tourniquet time and reduced blood loss. Technically the Smith and Nephew Visionaire instrumentation is particularly useful in cases where there is difficulty passing standard instrumentation such as the intramedullary femoral rod in cases of femoral mal-union or canal occlusion.
Author: Mr Richard Baker MD, MSc, MB.ChB, FRCS (Tr & Orth)
Institution : The Avon Orthopaedic Centre , Bristol ,UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
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The pass mark is 75%.
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- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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