Knee Replacement Surgery

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overview
Anatomy of the knee joint Common conditions leading to TKR Evolution of TKR Total knee replacement Our own data
Anatomy Of The Knee Joint

Three bones and three compartment
Midial
Knee Stabilizers
Lateral Anterior Posterior Rotatory
Common Conditions That Lead To TKR

OSTEOARTHRITIS
Primary (idiopathic) Secondary Post traumatic arthritis RHEUMATOID ARTHRITIS
Knee Arthritis
Far more common than hip OA in asian
population
Age: Sex:
80% above 75 years Equal in both sexes upto 45-55 years After 55 years more common in
female
Risk Factors Of Osteoarthritis

Increasing age Obesity Female sex Trauma Infection
Repetitive occupational trauma
Clinical Features Of Osteoarthritis
Depends upon stage of involvement I. Pain II. Loss of function III. Stiffness IV. Swelling V. Deformity VI. Crepitus
Radiological Features
Non Operative Treatment

Non pharmacologic therapy Patients education Use of assistive devices Weight loss Physical therapy Occupational therapy Pharmacologic therapy NSAIDS Glucosamine sulphate Intra articular Corticoteroids Intra articular Hyaluronic acid
Operative Treatment
Arthroscopy Osteotomy Knee replacement surgery
Arthroscopic Debridement
Osteotomy
Knee Replacement
Partial knee replacement Total knee replacement
Evolution of TKR
Fergussen(1860) resection arthroplasty Verneuil performed first interposition
arthroplasty 1940s- first artificial implants were tried when molds were fitted in the femoral condyle 1950s- combined femoral and tibial articular surface replacement appeared as simple hinges
Evolution of TKR (cont)

Frank Gunston(1971), developed a metal on
plastic knee replacement. John Insall(1973), designed what has become the prototype for current total knee replacements. This was a prosthesis made of three components which would resurface all three surfaces of the knee - the femur, tibia and patella
Classification of Implants Design

Unconstrained
Cruciate retaining Cruciate substituting Mobile bearing knees
Constrained (Hinged)
Un constrained TKR
Constrained TKR
Uni condylar TKR
Total Knee Replacement Today

Large variety is available Majority of TKR today are condylar
replacements which consist of the following

Cobalt-chrome alloy femoral component Cobalt-chrome alloy or titanium tibial tray UHMWPE tibial bearing component UHMWPE patella component
Who Is A Candidate For TKR

Quality of life severely affected Daily pain
Restriction of ordinary activities Evidence of significant radiographic changes
of the knee
What Is The Time For Replacement
Old age with more sedentary life style Young patients who have limited function Progressive deformity Other treatment modalities have failed TKR should be done before things get out of
hand and the patient experiences a severe decrease in ROM, deformity, contracture, joint instability or muscle atrophy
Evaluation Of Patient Before Surgery

A Complete Medical History Thorough Physical Examination Laboratory Work-up Anesthesia Assessment
25
Recommended Preoperative Radiographs in Knee Replacement Surgery
1. Standing full-length anteroposterior
radiograph from hip to ankle 1. Lateral knee x ray 2. Merchants view
Goal of TKR
Pain relief Restoration of normal limb alignment Restoration of a functional range of motion
Successful Results Depends upon:

Precise surgical technique Sound implant design Appropriate material Patient compliance with rehabilitation
Technical Goals Of Knee Replacement Surgery

1. The restoration of mechanical alignment, 2. Preservation (or restoration) of the joint line, 3. Balanced Ligaments 4. Maintaining or restoring a normal Q angle.
Mechanical Alignment
TKA aims at restoring the mechanical axis of the lower limb by: Sequential soft tissue releases Correction of bone defects by grafts or prosthetic augments
4. Ligament Balancing
a. Coronal Plane For varus deformities For valgus deformities b. Sagittal Plane
Flexion contractures Extension contractures
Procedure
Procedure
Procedure
Procedure
Procedure
Procedure
Procedure
Post Operative Rehabilitation

CPM
Rapid post-operative mobilization Range of motion exercises started Passive extension by placing pillow under foot Flexion- by dangling the legs over the side of
bed Muscle strengthening exercises Weight bearing is allowed on first post op day
Prosthesis Survival
Different studies shows different results Ranawat et al (Clin Orthop Relat Res) 95% at 15 years 91% at 21 years Gill and Joshi (Am J Knee Surg) 96% at 15 years 82% at 23 years Font-Rodriguez (Clin Orthop Relat Res) 98% at 14 years
Ward Data
Total no of TKR done in last one year:
cases Gender: Male . 5 cases Female.. 3 cases Age range: 40.65 years Cause for which TKR done: Osteoarthritis Bilateral/Unilateral: Single case for which bilateral knee replacement was done.
Case 1
Case 1
Case 2
Case 3
Case 5
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Anatomy Of The Knee Joint

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Lateral Anterior Posterior Rotatory

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Common Conditions That Lead To TKR

Primary (idiopathic) Secondary Post traumatic arthritis RHEUMATOID ARTHRITIS

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Risk Factors Of Osteoarthritis

Repetitive occupational trauma

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Clinical Features Of Osteoarthritis

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Non Operative Treatment

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Evolution of TKR (cont)

Classification of Implants Design

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Uni condylar TKR

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Total Knee Replacement Today

replacements which consist of the following

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Who Is A Candidate For TKR

Restriction of ordinary activities Evidence of significant radiographic changes

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What Is The Time For Replacement

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Evaluation Of Patient Before Surgery

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Recommended Preoperative Radiographs in Knee Replacement Surgery

1. Standing full-length anteroposterior

radiograph from hip to ankle 1. Lateral knee x ray 2. Merchants view

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Successful Results Depends upon:

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Technical Goals Of Knee Replacement Surgery

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Post Operative Rehabilitation

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