Claim OwnershipTotal Knee Tips & Pearls From Dr. Adam Rosen (A Virtual Total Knee Fellowship Podcast)
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© 2024 Total Knee Tips & Pearls From Dr. Adam Rosen (A Virtual Total Knee Fellowship Podcast)
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Dr. Adam Rosen is an orthopedic surgeon who specializes in total joint replacement. He created this podcast which is aimed at interns, residents, fellows, and general orthopedists who are looking to dive into the details of total knee replacements. I do not claim that my way is the best way or the only way. My personal approach to my patients, total knee replacement surgery and the ever important post-operative recovery has been developed over the years. My protocols are ever changing based on scientific evidence and personal experience.I know many of you will want to jump right ahead to the operative step episodes - and that is okay. The first few episodes are not as exciting but they do contain important information in my opinion. If you jump ahead just be sure to come back and listen to the first few episodes.I will attempt to offer you my brain and the algorithm within it. Here I will share my thoughts and my approach to caring for total knee replacement patients. I hope that you learn something from this podcast. I hope that my thought process stimulates your thinking and approach. Most importantly I hope that I can offer one or more tips or pearls that may benefit your patients. If you like the information and have a friend or colleague that you think would benefit from the material please be sure to share this podcast with them. (Disclaimer: This is my opinion. Any information gathered is not medical education. Practitioners need to use their education and experience to determine how to treat their own patients.)
102 Episodes
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After medical school, residency and probably fellowship it is time to find a practice. Here I will try to offer my two cents on what to think about and what to look for when you start looking for that first job out of training. Support the show
My name is Adam Rosen. I am an orthopedic surgeon in Southern California. I did my residency in Philadelphia and fellowship in La Jolla. I have been in practice since 2005 performing total knee replacements. I am part of a teaching fellowship program and I try to share my thought process with our fellows. I am going to share my thought process here in an attempt to help you and potentially the patients that you care for.This podcast series is really geared towards orthopedic residents or fellows or the community surgeon looking to pick up a pearl or two about total knee replacements. I do not believe that my way is the best way or the only way to care for patients with knee arthritis. I only offer my thoughts, opinions and treatment algorithms in the hopes that it will help you care for your patients. This is my opinion. You need to determine how to treat your own patients based on your experience, education and available scientific data. Support the show
Here I discuss some of the things I look for when seeing patients in the office when I am deciding on what treatment options are appropriate. Weight bearing x-rays are important. Ask patients to describe their symptoms. Do not simply ask someone to describe their pain on a scale of one to ten. Find out how their knee has affected their quality of life. Lastly, find out what treatment options have been tried and be sure to offer conservative treatment options to the patient before undergoing surgery. Support the show
Here I go into how I describe to a patient what a total knee replacement is by using a total knee model. I make it a habit to not only detail all of the potential risks of the surgery but I go into detail when certain risks are higher in an individual patient (such as infection risk in a diabetic). Explaining realistic expectations up front is extremely important in my opinion to create good patient satisfaction after total knee replacement surgery. I review with my patients normal expectations such as warmth, night pain, lateral numbness and clicking that can be seen in the early post-operative period. Support the show
I want to review the things that I look for in the pre-operative workup to help optimize patients in an effort to reduce the chance of a complication. I will discuss clearances, social habits like tobacco use and alcohol consumption, lab tests and nasal swabs. It is also important in my opinion to ask about prior anesthesia complications and potential allergies or reactions to materials that may be used during surgery. You need to think about prior incisions, retained hardware and consider if you need special implants for added constraint based on a patients exam. Support the show
I review what I double check the day before: labs, deformity, X-rays, implants and other things such as MRSA status, pacemakers or DBS. In the room I review my set up including the bed, lights, tourniquet and leg positioner. Review the plan with anesthesia regarding pain management. And sign your surgical site! Support the show
In this episode we get into the OR and start the surgery. It all begins with the TIME OUT. I review my approach and tips on marking the arthrotomy. I work in a circular fashion - medial release followed by superior followed by lateral and will review what I do and why. The removal of osteophytes at this point are important in my mind to increase exposure and decrease the risk of marginal fractures when using the saw later. Support the show
The PFJ and its kinematics are quite complex. When dealing with the patella during TKA you have many options on how to prepare the patella. Here I will discuss some of the options and go into detail how I expose and prepare the patella. Support the show
Here I will review my steps for the femur. The debate between CR and PS is as old as the debate between which came first - the chicken or the egg. The variables you control are the distal cut, the rotation, the sizing and more. Support the show
In this episode I will go over how I expose and prepare the tibia cut. I will go over things to be aware of such as the tibial slope, rotation, cut thickness and tips on how to accurately pin your block and cut the tibia. Support the show
Balancing a TKA is a long and complex topic. It is also an art. Individual biology can play a role. I will review some tips on what I look for when balancing a knee. The discussion will include both bony resections and soft tissue releases. I will also cover some areas where you may inadvertently affect the balancing while implanting the TKA. Support the show
Cementing is an art. The cement can be affected by the room temperature, humidity or how it is mixed. When you apply PMMA you want to be sure that the bone surface is dry. As you apply your implants you want to be sure not to alter the bone preparation or alignment, especially in osteoporotic bone.https://twitter.com/dradamrosenhttps://WWW.DRADAMROSEN.COM Support the show
Finishing up the TKA the closure is extremely important. I will review how I close and tips on what to watch out for to help get a "water tight seal." I will also share my post-operative photo that I believe helps patients get motivated and obtain good flexion. Support the show
I believe that these are all important so I wanted to re-review some important operative tips. I will review ways that you could potentially alter the alignment during the procedure. We will also go over ways to control the saw and decrease potential contamination and infection. Lastly, I will go over ways to be more efficient. Remember: slow is smooth and smooth is fast. Having a plan, working with teams and being purposeful can make you a more efficient surgeon. Support the show
Here I will give you a full audio walk thru of a typical TKA from draping to closure. Although previous episodes have gone into more detail of each individual part of the operation, this episode will take you through the procedure with a focus on knee position and retractor position from start to finish. This should hopefully build on what you have listened to in previous episodes.Again, I do not believe that this is the best or only way to do a TKA but it is a step-wise pattern that works well for me. Support the show
Pain control following a total knee is an art and a science. The idea of multimodal non-narcotic scheduled medication is a great improvement over the old way of treating pain. Here I will review my philosophy and algorithm for treating pain symptoms related to total knee replacement surgery. Support the show
The surgery is just one part of obtaining a good total knee outcome. The patient and their participation in post-operative PT is just as important to obtain a good outcome. A good total knee needs good range of motion and strength that will result in a well functioning total knee. Here I will discuss some of the tips I have used with my patients, and the reasons behind them, which have resulted in good outcomes and good range of motion. Support the show
Stiffness after TKA can be a big problem. The goal is to not develop stiffness and this begins with preoperative education, a technically well done TKA and appropriate post-op PT. Still, some patients may get stiff. Your goal is to capture those patients early so that there is still time to make a difference. Otherwise a MUA may be needed. Here I will share things that I have seen and tips that I have used to keep my rate of stiffness and need for MUA low. Support the show
In training we focus on the procedure. Unfortunately, some do not get enough exposure with the post-operative patient care issues. Here I will discuss some common things I see, how I educate my patients and what things to watch out for at both the one month and three month follow-up appointments. Support the show
I have had the idea of creating a podcast for quite some time and it has been a really interesting learning experience for me. I am grateful for all of the listeners and subscribers. My hope has always been to share my thoughts and tips in an attempt to give you one tip or tool that allows you to help one patient obtain a better outcome.In this last episode of Season one I just wanted to review briefly what we have talked about but reiterate some important pearls. My plan for season two is to talk about revisions, the workup of the painful total knee, infections, periprosthetic fractures and more.Once again, thanks for listening and stay safe. Support the show
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