Total knee replacement (tkr) Surgery

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overview

Anatomy of the knee jointCommon conditions leading to TKREvolution of TKRTotal knee replacementOur own data



Anatomy Of The Knee JointThree bones and three compartment



Knee StabilizersMidial Lateral Anterior Posterior Rotatory



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Common Conditions That Lead To TKROSTEOARTHRITIS

Primary (idiopathic)Secondary

Post traumatic arthritisRHEUMATOID 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 ageObesityFemale sexTraumaInfectionRepetitive occupational trauma



Clinical Features Of OsteoarthritisDepends upon stage of involvement

I. PainII. Loss of functionIII. StiffnessIV. SwellingV. DeformityVI. Crepitus



Radiological Features



Non Operative Treatment Non pharmacologic therapy

Patient’s educationUse of assistive devicesWeight lossPhysical therapyOccupational therapy

Pharmacologic therapyNSAIDSGlucosamine sulphateIntra articular CorticoteroidsIntra articular Hyaluronic acid



Operative Treatment

Arthroscopy OsteotomyKnee replacement surgery



Arthroscopic Debridement



OsteotomyEmail: [email protected]


Knee ReplacementPartial knee replacementTotal 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 retainingCruciate substitutingMobile bearing knees

Constrained (Hinged)



Un constrained TKR



Constrained TKR



Uni condylar TKR



Total Knee Replacement TodayLarge variety is availableMajority of TKR today are condylar

replacements which consist of the followingCobalt-chrome alloy femoral componentCobalt-chrome alloy or titanium tibial trayUHMWPE tibial bearing componentUHMWPE patella component



Who Is A Candidate For TKR

Quality of life severely affectedDaily painRestriction of ordinary activitiesEvidence of significant radiographic changes

of the knee



What Is The Time For ReplacementOld age with more sedentary life styleYoung patients who have limited functionProgressive deformityOther treatment modalities have failedTKR 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 SurgeryEvaluation Of Patient Before Surgery

A Complete Medical HistoryThorough Physical ExaminationLaboratory Work-up Anesthesia Assessment

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Recommended Preoperative Radiographs in Knee Replacement Surgery

1. Standing full-length anteroposterior radiographfrom hip to ankle

1. Lateral knee x ray 2. Merchant’s view



Goal of TKR

Pain reliefRestoration of normal limb alignmentRestoration of a functional range of motion



Successful Results Depends upon:

Precise surgical techniqueSound implant designAppropriate materialPatient 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 Ligaments4. Maintaining or restoring a normal Q angle.



Mechanical AlignmentTKA aims at restoring the mechanical axis of the lower limb by:

Sequential soft tissue releasesCorrection of bone defects by grafts or prosthetic augments



4. Ligament Balancinga. Coronal Plane

For varus deformities’For valgus deformities

b. Sagittal PlaneFlexion contracturesExtension contractures



Procedure



Post Operative RehabilitationRapid post-operative mobilizationRange of motion exercises startedCPMPassive extension by placing pillow under

footFlexion- by dangling the legs over the side of

bedMuscle strengthening exercisesWeight bearing is allowed on first post op day



Prosthesis Survival

Different studies shows different resultsRanawat et al (Clin Orthop Relat Res )

95% at 15 years 91% at 21 yearsGill and Joshi (Am J Knee Surg)

96% at 15 years 82% at 23 yearsFont-Rodriguez (Clin Orthop Relat Res )

98% at 14 years



Ward DataTotal no of TKR done in last one year: 8

casesGender: Male ……. 5 cases Female….. 3 casesAge range: 40…….65 years Cause for which TKR done: OsteoarthritisBilateral/Unilateral: Single case for which

bilateral knee replacement was done.



Case 1



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Case 1



Case 2



Case 3



Case 5Email: [email protected]


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Total knee replacement (tkr) Surgery

Health & Medicine

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