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.
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Question 1 of 14
What one ligament in particular must be checked before a valgus knee is replaced?CorrectIncorrect
Question 2 of 14
Which one pair of investigations are needed to manafacture a Visionaire cutting block?CorrectIncorrect
Question 3 of 14
If a patient has a fixed flexion deformity what one cut is most likely to need to be increased?CorrectIncorrect
Question 4 of 14
When dissecting the femur in preparation for the placement of the visionaire block one should?CorrectIncorrect
Question 5 of 14
Which one instrument should you use to check the distal femoral resection?CorrectIncorrect
Question 6 of 14
Which one of the following describes the reason for leaving the two anterior pins in the femur?CorrectIncorrect
Question 7 of 14
Which one movement of the tibia aids dislocation of the tibia anteriorly?CorrectIncorrect
Question 8 of 14
Which one part of the tibial cutting block should be applied to the tibia first?CorrectIncorrect
Question 9 of 14
Which one direction should the tibial plateau be rotated when being dissected and removed?CorrectIncorrect
Question 10 of 14
Which one of the following is the name of the sign that indicates correct external rotation of the femoral component?CorrectIncorrect
Question 11 of 14
Which one manoeuvre helps get access to the posterior aspect of the femur?CorrectIncorrect
Question 12 of 14
Which one of the following describes how much bone should be removed from the patella to resurface it?CorrectIncorrect
Question 13 of 14
The optimal cementing technique involves which one of the following pairs of actions?CorrectIncorrect
Question 14 of 14
A size 5 femur can implanted with which one of the sizes options of tibial tray?CorrectIncorrect