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Since malplacement contributes most to loosening of total knee replacements (TKR), a jig was devised, aligned to and mounted on the tibia, with a 3 degrees of freedom sliding saw. A central distractor, attached to the jig, positions and aligns the knee at 0 degrees or 90 degrees. The femur is then rigidly linked to the jig for bone cutting. Resurfacing designs (Cloutier and Townley) have been regularly implanted, aligned +/- 1 degree. This precision should minimize loosening and improve function.
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Cooke et al. (1985) studied this question.
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