Total knee replacement (tkr) 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



Knee Stabilizers
 Midial
 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: 80% above 75 years

 Sex: 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
 Patient’s 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
3. Lateral knee x ray
4. Merchant’s 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

O The restoration of mechanical alignment,
o Preservation (or restoration) of the joint line,
Balanced Ligaments
t 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



Post Operative Rehabilitation
 Rapid post-operative mobilization
 Range of motion exercises started
 CPM
 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: 8 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



v



Case 2



Case 3



Case 5



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Total knee replacement (tkr) Surgery

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