Melvin George

By Melvin J. George

Postoperative deep-vein thrombosis (DVT), venous thromboembolism (VTE), and pulmonary embolism are few of the most serious complications following total joint arthroplasty. Identification of risk factors and initiation of prophylactic measures are the most important measures to prevent the occurrence of DVT. Several protocols and guidelines are published for DVT prophylaxis in TKA, leaving the surgeon still perplexed. Pharmacological and mechanical prophylaxis methods are used to reduce the risk of postoperative symptomatic deep-vein thrombosis and pulmonary embolism. The use of pharmacological methods is based on a fine balance between their efficacy and the adverse effects associated with them. Each of these agents has their own advantages and disadvantages. Several newer agents are getting approved by FDA for the same. Hence, the choice should be carefully made based on the patient characteristics and risk stratification, and the onset of side effects has to be carefully monitored.

Part of the book: Primary Total Knee Arthroplasty

By Melvin J. George

Valgus deformity in total knee replacement is a much lesser encountered problem than varus deformity. The deformity can be caused by either bony or ligamentous pathology or both. Bone defects like lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodeling along with soft tissue pathologies like tight lateral collateral ligament (LCL), posterolateral capsule (PLC), popliteus tendon (POP), hamstring tendons, the lateral head of the gastrocnemius (LHG) and iliotibial band (ITB) can add to the magnitude of valgus deformity. Various sequences have been described to achieve balancing while doing a total knee replacement. Proper preoperative planning, clinical examination, necessary implant backup and good operative skill are mandatory to manage bone deformities or soft tissue pathology or both in valgus deformity. Obtaining an accurate axis restoration, component orientation and joint stability in a valgus knee with combined bony and ligamentous pathology may be a difficult task. The long-term results in valgus knees are relatively inferior to those with varus deformity. This chapter structure wise describes the pathology, classification of valgus deformity, radiographic planning, surgical approaches, method of valgus deformity correction, implant selection, associated deformities, precautions and intraoperative complications.

Part of the book: Knee Surgery