By S. A. V. Swanson (auth.), M. A. R. Freeman M.D. F.R.C.S. (eds.)
Early in its improvement, the subject material of any box of surgical procedure is just too ill-defined and critiques are too fluid for the construction of a booklet at the topic to be attainable. overdue in its improvement, controversy is at an finish, and even though it remains to be attainable to supply a textbook, it really is too overdue to provide a publication that would stimulate dialogue and crystallise principles. This publication has that aim, it being the Editor's view that the sector of the surgery of arthritis of the knee had reached a suitable intermediate degree in 1978 whilst this article was once written. 3 extensive concerns stand out as being short of solution earlier than the optimal kind of surgical operation for a given knee should be outlined extra convincingly than is feasible at this time: first of all: What symptomatic and actual good points of the knee are to be recorded pre- and post-operatively, upon the foundation of which comparisons may be made among the consequences bought by means of assorted surgeons or with assorted tech niques. The solution of this factor calls for basic contract not just upon what positive factors of the knee could be recorded yet, crucially, upon how those positive aspects should still to that end be provided that allows you to characterise a selected staff of knees.
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Additional resources for Arthritis of the Knee: Clinical Features and Surgical Management
Even if it conforms to the femoral component, the angle over which the two surfaces conform is limited by the geometry of the whole system, and the patella is effectively a shallow trough pressed against the femoral component (unless the designer goes out of his way to provide more constraint by arranging a protrusion on the patellar component to engage with a narrow groove on the femoral component); thus the twisting moment that can be applied is limited, and the fixation has effectively to transmit only compressive forces, which can of course be applied eccentrically.
As the knee was flexed from full extension, the pencil was found to draw a circle on the paper, thus demonstrating (directly and apparently without the possibility of misinterpretation) that the tibia rotates around a single, unmoving axis at the knee. This apparent conflict may be resolved when it is realized that the total movement of the instant centre is only a matter of a few millimetres, so that the area within which it moves can be viewed as a point in the context of the experiment described by DENHAM and BISHOP (see Chap.
Small movements in this direction would not induce much tension in the collateral ligaments, but would induce shear in the capsule. Little restraint would be added by the quadriceps and patellar system unless the patella were located on the femur in a groove, which in at least one design it is not. It must be concluded, as about the apparently inadequate arrangements in some designs for resisting hyperextension, that something that looks not quite right in theory works in practice. Added Constraints It has been assumed in the preceding discussion that the prosthesis is either a hinge (simple or modified) or a replacement for the surfaces of the femoral condyles and the tibial plateau (with some attempt to replace the shapes of the menisci).
Arthritis of the Knee: Clinical Features and Surgical Management by S. A. V. Swanson (auth.), M. A. R. Freeman M.D. F.R.C.S. (eds.)