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Would You Resurface Patella in TKR Exam Answer
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Would You Resurface Patella in TKR Exam Answer
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Segment:0 .
Hi, Robbie. That is a very good question, because these are one of the difficult questions in the vyver because you don't know where to start and where to end and how forceful you should be for 1 against the other. The message to give you and your colleagues regarding these type of questions and the similar question to this would be, for example.
Patella resurfacing or not, like you've mentioned, as well as posterior cruciate retaining knee or posterior cruciate subsequently knee or cemented stem versus Allen cemented stem or DHS versus short nail, et cetera, et cetera. Full stop. As y'all of all done orthopedics for four years, and you're joining us as consultants, you all will all be aware that these are questions where there's no real correct answer.
And it's I completely agree with Sean and the others that you cannot be dogmatic about 1 over the other at all full stop. The message, therefore, is for any of these questions, please start by saying that there's no clear evidence in the literature to support one over the other full stop. The second general point in this type of question is that please try to remember as to which table this question will be asked at.
Is it asked at the basic science table or is it asked other reconstruction or the trauma table? Full stop? The reason why this is important is that if it's asked at the basic science vibha table, then obviously it is a setting question to know your knowledge about the subject. But more importantly, it's leading to something in basic science where you're going to be marked upon.
For example, it could be leading to in patellar resurfacing or not on a free body diagram around the knee. For patella height, et cetera, et cetera. Or it could lead to if you're going to mention something about papers, it may lead you to a question onto NJR or paper interpretation, et cetera. Full stop. Hence, as you can clearly understand, these type of questions are not a pass or fail as to what answer you.
Give food stop. Obviously, if it's asked on adult reconstruction table, then the question is more about your breadth of knowledge on the subject, and I will tell you how to talk about that later. Full stop. Hence, I would answer this question about patella resurfacing not as follows. And please note, this is when I am asked this question on the basic science survivor table as patella resurfacing is concerned.
There's no clear evidence in the contemporary literature, both by long term survival studies, as well as patient reported outcome measures. Studies to completely support resurfacing or not full stop, then carry on to tell the examiner that generally there are three groups of surgeons their surgeons who always resurface the patella research, surgeons who do not resurface the patella and then they are selective resurfaces to stop.
From now onwards, you can go onto any of the two. I personally resurface all my patella, so I'll just tell you how I would tackle this question. Full stop. So carry on and say I, however. Oh, sorry, before I mentioned this, I wanted to add another point and say historical studies had shown a loosening rate of patients who were resurfaced, but those were using metal backed patella, which are not used now.
Full stop. Now I'm carrying on with my answers to resurfacing. And then I'll give you another answer as to if you want to say you do not resurface and carry on and tell the examiner. However, I do resurface all my patella because I want to recreate patella. Hi and optimal patella height is important for quadriceps function.
And that's why I reserve bitterly. However, as I've mentioned above, there's no clear evidence from the literature to support this, either from patient reported outcome measures or long term survival studies. Full stop. If you were going to say I do not resurface the patella, then you can say I do not resurface the patella. Even though I do know the patella height is important for quadriceps function in basic science studies.
However, in patient reported outcome measure studies and long term survival studies, there's no evidence to support this. Hence, I do not resurface the patella full stop. Now, let's suppose this was a basic science vivo table, and I was setting you up to ask you about patella height and the role it plays in a free body diagram of the knee and quadriceps function.
Then I would expect you to now draw the diagram, which how to draw very well, which is the FEMA and the tibia with the patella, with the quadriceps pull and the patellar tendon pull and another arrow, which will delineate and point out to the examiner to joint reaction force. Full stop. Hence, you will carry on and tell the examiner that I do know patella height is important for quadricep function.
However, at the same time, if the patella height is increased excessively, I do know it will have a detrimental effect on the joint reaction force and you will show it to him on the diagram would stop. So I hope you understand what I mean by these type of questions are not pass or fail. Is no right or wrong answer. But if you can use correct terminology like long term survival studies, patient reported outcomes of major studies, laboratory based studies to support or not support a particular part of the answer that will help you.
Full stop. I completely agree with everyone who mentioned points about this on patella resurfacing and once again to put it in a manner which is easily mentioned and not completely biased to one another. I will give you a few more points full stop. If you are saying that you resurface patella after you finish this, saying at about saying and mentioning the patella height issue, you can also say that by my resurfacing the patella, the potential for the need for further surgery if a patient has ongoing knee problems is avoided.
Full stop. You can once again clarify this by saying that once again, studies on patients who have had the patella resurfaced after a total replacement once again has not truly proven that there's a benefit in their pain. Full stop. Hence, I agree with one that it's a point worth.
Knowing about, but how to put it is probably in the way I have said stop. It is clearly not the reason why everyone should research the patella, however full stop. Then you can also mention that there is a suggestion that in patients with inflammatory or property like rheumatoid arthritis, the patella should be reinforced surfaced. But you can add that once again.
Evidence based medicine does not support that in either long term survival studies or patient reported outcome measures studies. Full stop. As regarding the issue of complications, it's concerned, you can mention that I do know that with resurfacing, there is a complication of a potential of patella fracture. Hence, in those patella, which are.
Then I would be very careful and do a minimal resection of the native patella and use the patella button to recreate patella height. Full stop. Lastly, some people do talk about the fact that they like to resurface Padilla because it will help in Padilla tracking. I would like to point out that how you can mention this to examiner is say that there is a suggestion that by resurfacing Padilla tracking it aids in Padilla tracking.
However, the most important determinant of what is important for better tracking is the correct femoral component position, and that is what I will aim to do. Hence, hence I've tried to her put the above points in a manner which you can try to exfoliate to other situations.
And I hope this helps, once again, this is my view and don't get too stressed or tense about. What is the correct answer? And lastly, if any of the exam going candidates in 4 February or.
Um, April live around hertfordshire, Essex, London. And if I'm doing any teaching sessions in Harlow, you'll are most welcome. And I do hope you found above useful. Many Thanks.
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