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Combination of Patient Specific
Instrumentation and Rapid Recovery
program – the best way to optimal
functional result of TKA
Dr n. med. Marek Czerner
OCR Korfantów
The main problem of this symposium
is how to improve our results of
treatment by TKA
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We have some tools to improve our
outcomes:
• Our brains and hands - the growing
experience and skills
• Our artificial brains – Computer Assisted
Orthopedic Surgery (CAOS)
• A well-trained team of doctors and
physiotherapists for rapid and effective
rehabilitation – FAST TRACK programme.
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Computer Assisted Orthopedic Surgery
(CAOS)
• Computer
Navigation
System (CN)
• Patient Specific
Instrumentation
(PSI)
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A set of surgical instruments to
perform the surgery TKA by PSI
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The main value of the PSI is precise
planning
• Surgeon can
modify all bone
cuts and
positioning
• Surgeon confirm
plan.
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PSI Technique – MRI three joints:
ankle, knee and hip
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PSI – technique – bone models
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PSI – technique – pin guides
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Arguments for PSI
• The best preoperative planning
• Better alignment 3 planes
• Precise bone cuts – the precise rotation and
gaps
• No intramedullary rods
• Less surgical times and instruments
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Arguments against PSI
• Extra costs (ca. 3000 Zł)
• Pure biomechanical bone cuts – we need soft
tissue release.
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PSI - literature
Initial papers by experienced surgeons:
• Boonen B,Schotanus MG, Kort NP. (2012) Preliminary
experience with the PSI total knee arthroplasty Acya
orthop. 83; 387-393
• Tienpont E. Improving Accuracy by Patient Specific
Instruments JB&JS Br. 94b (Supp.XXV) 247.
• Ng NV, De Claire JH, Berend KR, Lombardi AV jr
(2012) Improved Accuracy of alignment with patient
specific positionning guides compared with manual
instrumentation in TKA, Clin. Orthop. Rel. Res. 470;
99-107.
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PSI - literature
• Noble JW., Moore CA, Liu N; The value of patient
matched instrumentation in total knee
arthroplasty. J. Arth. 2012
• Silva A, Sampaio R, Pinto E; Patient specific
instrumentation improves Tibial component
rotation in TKA. Knee Surg. Sports Traumatol.
Arthrosc. 2013,
• Heyse TJ, Tibescu C.; Improved Femoral
component rotation in TKA using Patien specific
instrumentation. Knee 2012.
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PSI versus Computer Navigation
Availability
negative
CT/MRI necessary
negative
Accuracy
equal
Rotational aligment
positive
Wrong landmarks intra OP
positive
Tracker morbidity
positive
Less OR time
positive
Less versus more infrastructure
positive
Coss effectivness
positive
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The conclusion - why I chose PSI
• PSI – new CAOS approach
• Better compared to navigation
• Proper bone cuts
In all three dimensions
Teaching soft tissue release
• Cost effective
• PSI is the best way to improve the result of
TKA surgery
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How else to improve the results of
treatment with TKA?
Optimization of the treatment process through
the introduction of the Rapid Recovery
program.
• Standardised care pathway
• Standarised surgery
• Standarised physio and nursing care
• Planned length of stay. Discharge planned
prior admission.
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Recovery Pathway in OCR Korfantów:
• Day 1: admittion to the ward, education.
• Day 2: surgery and the beginning of the
rehabilitation, the first steps.
• Day 3 – 4: walking around ward, learning to
walk up the stairs, getting in and out of the
vehicle.
• Day 5: patient independent, discharged .
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Advantages for the surgeon:
• Optimization of the
treatment process
• Standarised anaestesia and
pain menagement.
• Reducing the risk of
infection
• Reducing the risk of DVT
• Intensification of treatment
- favorable economic
aspect
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Benefits for the patient
• Peace of mind with good
information and education,
the patient is braver in
improving more quickly
achieve the desired results
• Quick return to full efficiency.
• Good experience of
treatment in the hospital not afraid of re-treatment in
the second leg.
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Functional effect on discharge:
• The range of movement such as obtained
during surgery (full ROM),
• The possibility raised on a flat surface and up
the stairs.
• Quick and intense rehabilitation to prevent
thromboembolic complications – DVT.
• Reducing length of stay decrease the
possibility of infectious complications
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Summary:
• The Patient Specific Instruments are the
future today, and with further improvements,
I believe it will become the golden standard in
the orthopaedic practice.
• Rapid Recovery is the best way to optimize the
treatment process.
• Simultaneus execution of surgery PSI system
and Rapid Recovery program guarantee
complete treatment success.
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Thank you for your attention
Budowa nowego Bloku
Operacyjnego OCR
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