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Online ISSN 1827-1707
102nd CONGRESS OF THE PIEMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (S.P.L.L.O.T.) - Brescia September 9-10, 2005
NEW TECHNOLOGIES, MODERN INSTRUMENTARIUM IN ARTHROPLASTIC SURGERY
UPDATES ON KNEE ARTHROPLASTY
Federici A. 1, Federici M. 2, Grandizio M. 1
1 Unità di Ortopediae Traumatologia Ospedale S. Antonio, Recco, Genova
2 Clinica Ortopedica e Traumatologica Università degli Studi di Genova, Genova
The aim of a knee prostheses is to resolve the pain caused by the destruction of cartilage looking for a stable knee with a range of motion as similar as possible to the physiological one.
The sacrifice of the anterior crociate ligament is quite often performed. This can deeply modify the kinematics of the knee even if the posterior crociate ligament (PCL) is preserved.
The substitution of the PCL using a prosthesis with an intrinsic constraint (posterior stabilized) can not resolve problems due to a non physiological kinematics and can not avoid the wear of polyethylen (PE). Many under bearing video fluoroscopic studies have shown the direction and wideness of movements in a natural knee and in an artificial one. The rotating platform represents an arrangement between mobility and congruence and can improve articular kinematics allowing a better tracking of the femoral component on the PE: furthermore it allows the physiological lift-off and the screw home movements. The articular congruence is maintained for the whole range of motion and contact stresses reduced.
Problems of platform instability are quite not common, less then 0.5%. Some authors describe an higher percentual of complications; in our opinion, in these cases, complications are to ascribe to an uncorrect ballancing of soft tissues or to wrong indications. The rotating platform can forgive fair defects of tibiofemoral malalignment and of rotation of tibial component but requires a carefully balancing.