1. BRIGET LOJAK
ADVANCEMENTS OF TOTAL KNEE
REPLACEMENTS: WHEN IS THE RIGHT TIME?

2. LEARNING OBJECTIVES
• Understand the anatomy of the knee as well as the different components that go into a
total knee replacement.
• Learn the common causes and pre existing symptoms you may experience leading to
osteoarthritis and knee replacements.
• Going through the rehab process and understanding how important pre-habilitation and
professional rehab post-surgery are to returning to activities of daily living.
• Limitations you may have post-surgery as well as functional activities and sports you
could partake in.

3. ANATOMY
• BONY
• Femur
• Tibia
• Patella
• SOFT TISSUE
• ACL
• PCL
• Meniscus
• Articular Cartilage

4. • Extreme pain
• Limited range of motion
• Previous surgeries to the knee
• Muscle atrophy
• Locking/catching within knee
• Chronic inflammation
• Deformity
• Unable to kneel down
• Lack of function
• Limiting activities of daily living and/or hobbies
PREEXISTING FACTORS LEADING TO
TOTAL KNEE REPLACEMENTS (TKR)

5. COMMON CAUSES FOR TKR
• Osteoarthritis – account for 96% of all total knee replacements
• Osteo – bone
• artho – joint
• itis – inflammation
• Rheumatoid Arthritis
• Synovial membrane surrounding joint becomes inflamed and thickened
• Autoimmune disease
• Chronic inflammation can lead to cartilage loss, pain, stiffness
• Post-traumatic Arthritis
• Following a serious knee injury - fracture of bone, tearing of ligaments
• May lead to damaged cartilage, pain, loss of function

6. OSTEOARTHRITIS
• Causes:
• Aging*
• Overweight/Obese
• Poor strength/flexibility
• Hereditary
• Gender – women over 55
• Job/Sport
• Symptoms:
• Joint aching/soreness
• Stiffness/limited movement
• Swelling
• Warmth
• Creaking of joint
• Unable to perform activities of daily
living
• Walking, kneeling, stairs
* - Most common

7. FACTORS LEADING TO OSTEOARTHRITIS
Overweight / Health Conditions
Body Mechanics
Job / Sport
Previous injury

8. OVERWEIGHT / HEALTH CONDITIONS
• Weight adds a major increase of stress on joints
• Every 1 pound of weight loss reduces 4 pounds of stress on a knee
• Overweight individuals account for 1/3 of all joint replacements
• More than 2x more likely to develop infections
• Osteoporosis
• Increase chance of stress fractures due to bones becoming less dense
• Effects of diabetes:
• Increase stiffness in the joint
• Type 1 -  risk for bone / joint disorders
• Type 2 -  chance of osteoporosis

9. BODY MECHANICS
• Q-angle – line of pull of quads & patellar tendon
• High Q-angle leads to mal-tracking of patella
• Normal measurement:
• Male: 13 degrees
• Female: 18 degrees
• Flat footed/High arches
• Scoliosis
• Leg length discrepancies
• Can affect how stress is absorbed in the knees
• One may take on more stress than the other

10. JOB / SPORTS
• Impact sports
• Increased stress on joints
• Long distance running, football, basketball, singles tennis
• Can lead to injuries such as:
• Ligament tears
• Meniscal tears
• Fractures
• High impact, high duty jobs
• Body positioning
• Bending and lifting techniques
• Constant kneeling

11. PREVIOUS INJURY
• Can alter body mechanics and lead to osteoarthritis
• 5X more likely to develop Osteoarthritis in previously injured knee
• Examples:
• ACL/PCL Tear
• Meniscal tears
• Chondromalacia
• Osteochondritis Dissecans
• Fractures

12. CONTRAINDICATIONS TO TKR
• Infection
• Severe vascular disease
• Neuropathic joint
• Obesity
• Skin diseases

13. STATS ON TOTAL KNEE REPLACEMENTS
PROS CONS
Pain Relief Implant malfunction
Enhanced ROM/Improved Mobility Infections/Blood Clots
Better Quality of Life Lengthy rehab
90% are completely satisfied –
longer life of implant
YEARS # of TKR Average Age
1991 93,230 65 - 80
2010 243,802 45 – 84
37% - Male
63% - Female
2030 3.48 million -

14. MYTHS FACTS
I have to wait until I am at least 60 so the
joint will last longer.
A lot of replacements are being done as
early as 50 years old. Increased technology
and research of replacements has
increased life expectancy to 20 – 25 years
or even a lifetime!
I should continue taking pain medication
and try to put off surgery as long as
possible.
Living with pain  quality of life. Waiting too
long could impact the outcome of rehab.
Continuous use of pain medication also has
dangerous health effects and risk of
addiction.
I’ll lose my range of motion.
Post-op range of motion is related to the
range of motion knee has pre-operation.
Often times  ROM.
I will have to get a total knee replacement
even though only part of my knee is
damaged.
If partial is possible –smaller incision,
preserve natural bone and ligaments (feels
more natural)
I’ll never be able to play sports again!
No impact sports but possible sports
include: cycling, swimming or golfing.

15. TYPES OF KNEE REPLACEMENTS
• Total knee replacement
• Removes components of both the Femur and Tibia
• Partial
• Only removes damaged surface from one bony component
• Techniques used:
• Traditional
• Minimally invasive
• Robotic

16. TOTAL KNEE REPLACEMENTS
• Remove damaged surfaces of joint
• Replaced with implant made up of metal and plastic
• Held in place using either cemented, non-cemented, or combo of both

17. TOTAL KNEE REPLACEMENTS
• Replacement is made up of three pieces
• Tibial
• Femoral
• Patellar
* - Most common

18. BEFORE & AFTER SURGERY
• Before surgery:
• Begin rehabilitation to build up muscle and stability
• Knowing the exercises before hand will aid in a speedy recovery
• After surgery:
• Adhere to limitations set by doctor
• Attend and stick with rehab!!!
• Gradually begin light, low impact activities to tolerance
• Walking, swimming
• Avoid high impact activities
• Long-distance running, basketball, downhill skiing, impact aerobics

19. REHAB
• Rehab is a key factor in returning to activities of daily living after a total knee replacement
• Home care for the first 1-2 weeks (assistance recommended)
• Begin rehabilitation in a clinic after completing home care
• Recovery can take anywhere from 3-6 months of rehab
• First 90 days are crucial for regaining full ROM
• Full recovery up to a year!
• Aquatic therapy is a great way to gain confidence and range of motion

20. EXPECTED OUTCOMES
• 90% of patients experience complete pain relief and are completely satisfied
• Other 10% may experience reoccurring pain due to
• Implant malfunctions
• Surgery complications
• Other injuries throughout the body / poor health
• Poor dedication to pre and post rehab
• ROM after surgery is largely related to ROM before surgery
• Most patients knee flexion returns to anywhere from 90-125 degrees
• Pre-hab can help to increase ROM both before and after surgery!

21. PREVENTION
• Switch to a different sport – lower impact
• Orthotics for leg length discrepancy or arch support
• Lose / manage weight
• Strength and flexibility – equal on each side
• Strong muscles and flexible joints to keep knee stable but able to smoothly complete
full range of motion
• Implement some level of physical activity in your life

22. TAKE HOME TIPS
• Focus on prevention tips to keep knees safe and healthy!
• If you have limitations of weight and/or pain aquatic therapy is a great alternative!
• Medication – pain medication, NSAIDs
• Do not use as a chronic solution
• Take into consideration the length and demand of rehab when determining when is the
right time
• Discuss with doctor possible options
• Get a second opinion
• Pre-hab is a must if scheduled for a total knee replacement