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Dr Surendra OjhaAssociate Professor

MPT Ortho/MusculosketetalMGUMST JAIPUR

overviewoverview

� 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

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Common Conditions That Lead To TKR� OSTEOARTHRITIS

Primary (idiopathic)Secondary

Post traumatic arthritis� RHEUMATOID ARTHRITIS

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Knee ArthritisKnee Arthritis

� Far more common than hip OA in asian population

� Age: 80% above 75 years

� Sex: Equal in both sexes upto 45 -55 yearsAfter 55 years more common in female

Risk Factors Of OsteoarthritisRisk Factors Of Osteoarthritis

� Increasing age� Obesity� Female sex� Trauma� Infection� Repetitive occupational trauma

Clinical Features Of Osteoarthritis� Depends upon stage of involvement

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

Radiological Features

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Non Operative Treatment � Non pharmacologic therapy

� Patient’s education� Use of assistive devices� Weight loss� Physical therapy� Occupational therapy

� Pharmacologic therapy� NSAIDS� Glucosamine sulphate� Glucosamine sulphate� Intra articular Corticoteroids� Intra articular Hyaluronic acid

Operative Treatment

� Arthroscopy � Osteotomy� Knee replacement surgery

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Arthroscopic DebridementArthroscopic Debridement OsteotomyOsteotomy

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

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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 patellafemur, tibia and patella

Classification of Implants Design

� Unconstrained � Cruciate retaining� Cruciate substituting� Mobile bearing knees

� Constrained (Hinged)

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Un constrained TKRUn constrained TKR Constrained TKRConstrained 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

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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 atrophyatrophy

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Evaluation Of Patient Before SurgeryEvaluation Of Patient Before Surgery

� A Complete Medical History� Thorough Physical Examination� Laboratory Work-up� Anesthesia Assessment

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Recommended Preoperative Radiographs in Knee Replacement SurgeryKnee Replacement Surgery

1. Standing full-length anteroposterior radiographfrom hip to ankle

1. Lateral knee x ray 2. 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

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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 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

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4. Ligament Balancing4. Ligament Balancing� a. Coronal Plane

� For varus deformities’� For valgus deformities

� b. Sagittal Plane� Flexion contractures� Extension contractures

ProcedureProcedure

Procedure Procedure

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Procedure Procedure

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ProcedureProcedure ProcedureProcedure

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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

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Prosthesis SurvivalProsthesis Survival

Different studies shows different results� Ranawat et al ( Clin Orthop Relat Res )

95% at 15 years91% at 21 years

� Gill and Joshi (Am J Knee Surg)96% at 15 years82% at 23 years

� Font-Rodriguez (Clin Orthop Relat Res )98% at 14 years

Ward DataWard 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

Case 1

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Case 2

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Case 3

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Case 5

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