Chapters Transcript Video Dr. Kevin Fricka Performs a Live Surgery of a Lateral UKA Procedure Using the JOURNEY™ II UK System This video is a surgical technique overview of a lateral technique. Dr Kevin Fricka, part of the Anderson Orthopedic Clinic. I'm here at Harborside Surgery Center in Maryland. We're right outside of DC in Alexander, Virginia. We're going to do a lateral partial knee replacement with the new journey. Two unique compartmental knee system. We've got a 66 year old female, she's post lateral mastectomy in her twenties and you can see she's gone on to lateral compartment, arthritis, you know, best seen on a P A flexion view. You can really see where the arthritis is. Her knee cap or patella area is pristine. And in this case, you know, given her minimal deformity, we did do a stress view and the key here is we can see the medial compartment is the same, the lateral compartment opens up and we still maintain her neutral to slight valgus alignment. As in the side here, you can either do a lateral partial knee replacement through a medial incision or go lateral per teller. In this case, she has a previous lateral incision. So instead of my standard straight incision, we're going to use her incision and have it curved a little bit. Ok. So we're going to use her old incision, you come down and curve it. Essentially. Her turi is here and her paella is here here. If we draw that out, that's the patella. Ok. So normally it would be sort of a midline incision through here. But with the previous incision, this is how we'll do it again. So the benefits of doing it through a lateral approach in terms of when they compared them head to head was a little better range of motion. And you may be able to do it through a little smaller incision, a little quicker recovery than from the medial side. When you do it through the medial side, you just got to make sure you don't cut the medial meniscus. So we're going to just elevate the leg here and we're going to raise the tourniquet. So what we see here, you know, this is key to lateral arthritis, the distal cartilage still looks, ok. So when they're standing straight or, you know, with their legs straight, it's not too bad. And then you go to the post ear con and the post ear porch and it's completely worn out, you know, that's bone to bone. So lateral compartment disease usually hurts going down the stairs, you know, and it is best seen on that P A flexion view that we talked about because of the fact that it's sort of a post your wear pattern. Ok. So again, different ways, but this allows us to tension the joint and then set our depth resection, but you can also use it with the stylus. Again, that goes in nice and easy. It's resting where it needs to rest. And then we put our tibial guide on. Again, we set our alignment and slope and everything here. So then, you know, again, this way, we use this eight that sets us for an eight polyethylene. If you show me the stylus, a lot of people will also use the stylus. Again, the stylus just goes into here and you can look at the depth of your section. This comes in two and four and three and five, depending on the depth of your tibial cut. But both, both ways are good to do. It just depends on your preference. I'm sort of used to this spoon technique and it allows us to essentially get an eight millimeter cut every time. So we slide this on and then slide it in. There we go. Once that's in position, then we're gonna check our alignment and we're gonna hold this in position to set the depth of our cut. Again, one pin, we just use the one pin here to hold our tibial guide in position. OK? We take this off. OK. And then we're gonna just, I always like to check in on the lateral side. We do not want a big cut because she's passively correctable. And we don't really want that big of a cut, but we just check it to make sure we may adjust it half a millimeter or so. And then again, it's a one pin technique. We just tighten the guide and we take the song and we're gonna make our studio part. So we wanna make sure. So there's the AC L, we see the AC L on a media union, we might want our cut to be more like this on a lateral unit. We really want to internally rotate our cut for the screw home mechanism. She still has a little bit of an osteophyte down here then. OK. So then we can just take that retractor and protect the AC L. OK? I don't have a retractor over here because I want to make sure that I'm allowing myself to internally rotate this as best I can. And so we really want instead of it like straight out, you know, there's the A cli want this cut to be, you know, internally rotated. And a lot of people actually, or some people might cut through the tendon, you know, if they don't get enough internal rotation. OK. So again, we're going to take this here double side of the, gonna take this and made that a vertical top. Now, you have to understand the lateral side of the spine is not prominent. So a lot of times your cut is very minimal, I'm just gonna finish this off this way. Take that as an osteotome come out with both of those. Again, on the lateral side here, we usually want a pretty minimal cut. And in this case, you know, that's what we've accomplished console. It's a very minimal cut. OK? Probably. But if we look at our alignment that looks not bad, we might need to cut 11 more. But let's see, the eight spacer block. So again, we have an eight and a nine, OK? If you cut too small, the red one, you know, red is recut. So if you can only get a six or a seven in, it means you might need to re cut the tibia in her case. Um, you know, the eight is maybe a little snug. Um but still keeps her in Valgus. Uh That's not bad actually. Um So I'll show you the way to recut the Tibby edges so you can see that. Um And we might take a half a millimeter in this system you could if you want. So we'll take the tibial jig here, ok? We've locked it in place, you know, you can put this on like this. You can just, if you wanted to open it up, you know, dial it down one or two or a half a millimeter, tighten it back up, you know, and if you want to make that cut, you can, and you can see we're just barely thinking you because we don't really want a big cut. So now we can take this off because we know the eight was pretty good. Anyway, it was just maybe a half a millimeter tight. So we were just shaving a little extra. We'll make sure that we've completed that cut all the way to the notch saw bank. And there we go, Tonsil then. Ok. We'll come a bit back down and do extension and check the gray eight. You know, now that goes in very easy. Ok. So we'll do that as our cut, ok? If I needed to, we could take one more or one less femur. But in this case, we're going to do the standard resection, which is 6.5 millimeters. That's the thickness of the femoral component. And so we just put this guide in like this, OK? Let's have a mallet for a second. This is a pretty tiny individual. So the black guide is going to stick out just a little bit pin driver and we'll pin this in place and then we'll cut our distal femur. So just one pin here again, we're gonna take the saw and we're gonna cut our distal femur. So now we can take this off because we know the eight was pretty good. Anyway, it was just maybe a half a millimeter tight. So we were just shaving a little extra. We'll make sure that we've completed that cut all the way to the notch saw bank and there we go tonsil then OK? We'll come back down and do extension and check the gray eight you know, now that goes in very easy. OK. So we'll do that as our cut. OK? If I needed to, we could take one more or one less femur. But in this case, we're going to do the standard resection, which is 6.5 millimeters, that's the thickness of the femoral component. And so we just put this guide in like this, OK? Let's have a mallet for a second. This is a pretty tiny individual. So the black guide is gonna stick out just a little bit pin driver and we'll pin this in place and then we'll cut our distal femur. So just one pin here. Again, we're gonna take the saw and we're gonna cut our distal femur. All right. So now we're gonna check our gaps again, we cut our distal femur and we cut our approximal tibia. So we use the eight millimeter resected block, ok? Again, that should just go right in like that pretty easy to go in, you know, corrects her deformity a little bit, gets her straight. We like the eight, OK? And we come to the reflection and we're gonna do the gray eight. OK? Take the gray eight and that's easy to get into. So you can see that nice and easy reproducible. The eight goes in. So we're balanced and extension and flexion at eight millimeters at this point, you know, sometimes now you're going to just make sure that your femoral cut was all the way through. We're going to take out some osteophytes along the femur as well. And we'll use that now again, two different ways to do this. You can either use the spacer block and attach this to it and then slide that on like that or you can use the T handle, which is what I prefer. You just grab it in the center. OK? And then you're going to just put it for your femur. Now, here, you know, I was wrong. It's probably a five on the lateral side. However, you don't want it to be too tall because you don't want to impinge on the patella. But we still have, we could probably do a five. So let's see what the five looks like. Again, the nice thing is four and five right now, the lug holes are the same. So whatever block I cut with it can still work. OK? I think I like the five a little better, but we'll finally size it again. One key thing on here you can see is you can see where the four is as well. So if you look closely on here, there's a black line around it which indicates where the four would be. Um So, you know, just a way to do it. Now, we want to make sure our post ephemeral cut is parallel to our tibia, which it is. And we're just going to finish pinning this guide the one out here and then I pinned it with three. You could probably get away with pinning it two. But so, OK, now again, we could drill our lugs right now because I'm pretty confident this is where we want to be. But this system allows you to move the femur, medial or lateral. You drill those two holes and that's the set point for the femoral drill through trial. So you don't have to commit to your medial or lateral position. Good. We finished that. We come up here pin, Driver Stephanie's gonna grab these pins and just the process of taking pins out. We're going to take our sizing stick again, we're going to hook it to the back and look, it looks like a four or five. So let's see that. Now again, what we look at here is these are and I don't know if the camera see it but they're, they're short but fat. So that's the lateral side is short and fat. So there's the five and we look at a four here and a four looks spot on in the previous, you might have some overhang in the front. But in this case, you know, we, we no longer have that because again, we're a short component but a wide component. OK? And we're going to just impact this into place. Again, I, I do it this way some people are gonna prepare right away, but I like to get the trial in. You really got to just hit it a little bit to get the keel down. So, but again, we see we're not overhanging in the front. OK? Here's the, now we're gonna put the femur in and again, the spikes. So we see those spikes. That's that home position. And you can see back here how it allows the femur to move, you know, a few millimeters. So we find our home position, which is here, we take the orange impactor. I think he's there. I appreciate my time there. You have a tibial impact there to be a crazy lifting. Just a little. Our lines line up pretty good. I don't think we really need to move it much, but you can move it just a little bit there. If you need it to orange impact there, be secured in place with the pin, you just make sure that it's fully flushed. And now we're going to take the eight trial. I'm gonna put the eight trial in place, gonna bring the leg out to extension, ok? We gonna see. So there again, if we look here, she's fully straight. OK? She still is in slight vagus, you know, we've got good correction. We're going again, check with an objective measure two millimeter thick on the amber guide on the thin side, three millimeters on the flexion side. So an extension and we want this to go in pretty good and I mean in in flexion, you know, we want the three to go in the three goes in very easily. You know, we can check the two that we know the two goes in and again, the two and extension, you know, easily come in and out. So we like what we have here in terms of position. We can see that the tibia is not. Um, so the screw home mechanism and I don't know if you can see this here if you can come over the top of it or not. But you can see that if we didn't rotate this tibia right now, the femur is right in line with the tibia. If this tibia was rotated externally, those two might not be right on each other. Again, you want to make sure that's internally rotated a little bit. And again, our thermal component is not overhanging the cartilage. So it is not at all gonna impinge on the patella. OK? You can take it through a range of motion. We like that. We like our stability. So we're going to open up those pieces. Let's have this pick up. We're gonna get rid of a little bit of this fat just for visualization. And we're gonna use this tool to secure the femur slide it off. We're gonna slide our a polly out. We're going to take our drill and we're going to prepare our tibia. Again. I like to some people use that little spike, but I like to just put the drill bit in there. It's a visual reference for the way these lugs are drilled again, they're slightly posterior, they're not straight up and down drill that and then we're gonna use the drill to, to then she's, you know, the tibia is the most important cementing part. We're going to, again, cement in two stages. So we can have two half batches of cement open and put it on the tibia. I use an osteo to, to spread it around and good trier. Mhm You can put it on the tibias Stephanie, you can put it on the tibia again, you know, pressurize your loads, you know, you want cement, you don't want a ton of cement because you don't want it stuck in the back of the knee. So you usually take this oxy and sort of scrape some of that off. Then same thing on the tibial component. Again, you want some cement in the back but not a ton of it. You're going to put this in. We start first with a Chandler pushing on the poster aspect of the tibia. OK? We push that down and then we work it to the front. We can see all of that cement, you know, come out in the front and you know, I think this really shows it here nicely. We have no overhang of the tibial component on this side. You know, in the past when we might have had the other uh you know, the medial side onto the lateral side you would get a little bit of overhang of that. Um We're going to use that. I'm also going to take the smaller tibia one smaller impactor for the Timbia. Good. You know, you can use either that microscope or this one to impact the tibia. I just wanted to get a little infection in the back. Then I use these spacer blocks to finish pressurizing the tibia. OK. You know, the lateral side is looser inflection. So a lot of times you can be one higher on that spacer block. But that allows you to really help with pressurizing that we're going to finish cleaning that cement. But we don't have to worry about sizing and overhang here. But because you know, these components fit very nicely on the lateral side, again, we just spend time in the back of the knee with these scrapers scrape around. You know, the tibial component also is beveled. So it's soft tissue friendly and also allows for getting the cement out pretty easy. It's a little lower profile post yearly as well. So, you know, you can see some hidden cement back there as well and it's always hidden in this corner again, with this Smith and Nephew Journey system. You know, it's very easy to do manually, but also it's robot friendly as well. So you can do it with the robot. You don't need the jigs, but manual instrumentation allows you to do it perfect every time the robot does as well. So you can choose how you like to do your partial needs. We're in a surgery center right now. So, you know, but the nice thing about Corey is it's surgery center friendly. You have two rooms, you can move back and forth. You know, that's the robot platform. So it's an option if you want to do it. I'm just saying we here have done manual instrumentation for a while. So we're going to pressurize that into these holes. Good. We're gonna put it on the thermal component, you know, and the partial knee is a, is a sc friendly. All these, you know, all of us want to be doing joints in, in A S CS. Well, the easy way to start is with the partial knee. You know, these people go home, you know, they don't stay and they don't have as much pain as a total knee. It's not no pain, but they just don't have as much pain as a total knee. Yeah, we're gonna then cement the femur. You're gonna see come in here and use a packer. I always keep my hand on the tibia just to avoid any lift off or anything. And yeah, you join me. Excellent job here hitting this in place. Good. Ok. Here, clear out the cement, get it off the oxen. Let's see. The eight and a lot of times cement will hide, you know, down here, orange looks good right now. We're gonna take this, put that in place. Bring it back here. Come out. Yeah. Good Amber guide. And now we're just going to pressurize and allow the cement to cure. She's, she's pretty straight. She's still slightly in Valgus. We're going to go ahead and take the eight polyethylene. We can put our hand in here as well. Feel the it band and the it band should have a little bit of attention to it. Um And we're just going to let this cement dry and then put the final polyethylene in closure. Standard number one, a barbed suture for the capsule two Os and then Monocryl. Um So you want to uh make sure it's engaged, you cannot push it back further and then you just take the handle, you hook it into the front here just like this, squeeze down, locks it in place. You hear a click. OK. There's our need. Again, if you look here, we've got, you know, the excellent component component position, we're right in line with each other here, the interpretation of the tibia. And, you know, she's got excellent flexibility as well. So, you know, another successful partial knee, let's have the bump and we'll start uh closing because we already washed. Right. Yeah. Published Created by Related Presenters Kevin B. Fricka, MD
