Primary TKP form
naam patient *
Your answer
voornaam patient
Your answer
geslacht
date of birth
MM
/
DD
/
YYYY
GSM nr of telefoon nr as indicated on sticker
Your answer
date of surgery
MM
/
DD
/
YYYY
surgeon *
Side of surgery *
Primary diagnosis
Charnley Function Classification *
alignment measured on AP standing X-Ray *
mediolateral instability *
anteroposterior instability *
preoperative extension (deficit note as -, hyperextensie note as +) *
preoperative flexion *
preoperative pain *
intraoperative complication *
configuration *
Order of Resection *
Surgery Time (mins)
Your answer
Tourniquet Time (mins)
Your answer
femoral size *
valgus femoral *
Tibial Tray size *
PE thickness *
Anesthesie *
Required
Deep Approach *
How Did You Manage Patella *
Patella resurfacing *
Patellar Size *
Trumatch, Visionaire
Bone Cement *
Balancing *
exorotatie (graden) *
Soft Tissue Release *
Required
postoperative extension *
postoperative flexion *
medial stability at 0 degrees *
medial stability at 30 degrees *
medial stability at 90 degrees *
lateral stability at 0 degrees *
lateral stability at 30 degrees *
lateral stability at 90 degrees *
remarks
Your answer
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