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- Talk
- 24/06/2023
- CANADA
Surgical Pearls for Knee Replacement in Patients With Obesity
Description
This presentation focuses on the nuances of knee replacement surgery, particularly addressing challenges faced by younger and often obese patients. Dr. Bheeshma Ravi starts with a discussion on the distribution of fat in these patients, which can complicate the surgical approach. He emphasizes a conservative incision technique to ensure optimal access while minimizing potential complications associated with excessive soft tissue.
Key points include:
- The aggressive approach necessary to manage increased soft tissue around the knee and the importance of tool positioning to aid in maneuverability during surgery.
- The varying bone quality in younger, obese patients—sometimes surprisingly osteopenic, contrary to expectations—necessitating a lower threshold for using stems to distribute load during the procedure and prevent fractures.
Dr. Ravi discusses issues such as exposure difficulties due to girth and recommends positioning techniques that optimize surgical visibility, alongside the need for careful synovial tissue management due to the agitated nature of the patient's condition. The talk includes insights on the application of arthrotomy techniques to enhance exposure and the benefit of aggressive synovectomy in these cases.
The discussion also covers practical considerations, such as how to approach bony landmarks that may be obscured due to fat tissue and the advantages of using intramedullary guides for alignment. The surgeon's preference for cemented implants is noted, along with evidence indicating that patients requiring revisions tend to experience aseptic loosening.
Dr. Ravi highlights that the outcome of knee surgeries in these patients often surpasses expectations once postoperative swelling diminishes and gravity assists in restoring range of motion. Ultimately, the talk underscores the need for adaptability in surgical techniques to cater to the specific anatomical and physiological challenges presented by younger, higher BMI individuals.