Total knee replacement (tkr) ppt


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i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.

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Total knee replacement (tkr) ppt

  1. 1. Dr Shams ur Rehman Wazir PG Trainee Orthopedics B Unit Hayatabad Medical Complex Peshawar, Pakistan [email_address]
  2. 2. overview <ul><li>Anatomy of the knee joint </li></ul><ul><li>Common conditions leading to TKR </li></ul><ul><li>Evolution of TKR </li></ul><ul><li>Total knee replacement </li></ul><ul><li>Our own data </li></ul>
  3. 3. Anatomy Of The Knee Joint <ul><li>Three bones and three compartment </li></ul>
  4. 4. Knee Stabilizers <ul><li>Midial </li></ul><ul><li>Lateral </li></ul><ul><li>Anterior </li></ul><ul><li>Posterior </li></ul><ul><li>Rotatory </li></ul>
  5. 6. Common Conditions That Lead To TKR <ul><li>OSTEOARTHRITIS </li></ul><ul><li>Primary (idiopathic) </li></ul><ul><li>Secondary </li></ul><ul><li>Post traumatic arthritis </li></ul><ul><li>RHEUMATOID ARTHRITIS </li></ul>
  6. 7. Knee Arthritis <ul><li>Far more common than hip OA in asian population </li></ul><ul><li>Age: 80% above 75 years </li></ul><ul><li>Sex: Equal in both sexes upto 45-55 years </li></ul><ul><li>After 55 years more common in female </li></ul>
  7. 8. Risk Factors Of Osteoarthritis <ul><ul><li>Increasing age </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Female sex </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Repetitive occupational trauma </li></ul></ul>
  8. 9. Clinical Features Of Osteoarthritis <ul><li>Depends upon stage of involvement </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Loss of function </li></ul></ul><ul><ul><li>Stiffness </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><li>Deformity </li></ul></ul><ul><ul><li>Crepitus </li></ul></ul>
  9. 10. Radiological Features
  10. 11. Non Operative Treatment <ul><li>Non pharmacologic therapy </li></ul><ul><ul><li>Patient’s education </li></ul></ul><ul><ul><li>Use of assistive devices </li></ul></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Physical therapy </li></ul></ul><ul><ul><li>Occupational therapy </li></ul></ul><ul><li>Pharmacologic therapy </li></ul><ul><ul><li>NSAIDS </li></ul></ul><ul><ul><li>Glucosamine sulphate </li></ul></ul><ul><ul><li>Intra articular Corticoteroids </li></ul></ul><ul><ul><li>Intra articular Hyaluronic acid </li></ul></ul>
  11. 12. Operative Treatment <ul><li>Arthroscopy </li></ul><ul><li>Osteotomy </li></ul><ul><li>Knee replacement surgery </li></ul>
  12. 13. Arthroscopic Debridement
  13. 14. Osteotomy
  14. 15. Knee Replacement <ul><li>Partial knee replacement </li></ul><ul><li>Total knee replacement </li></ul>
  15. 16. Evolution of TKR <ul><li>Fergussen(1860) resection arthroplasty </li></ul><ul><li>Verneuil performed first interposition arthroplasty </li></ul><ul><li>1940s- first artificial implants were tried when molds were fitted in the femoral condyle </li></ul><ul><li>1950s- combined femoral and tibial articular surface replacement appeared as simple hinges </li></ul>
  16. 17. Evolution of TKR (cont) <ul><li>Frank Gunston(1971), developed a metal on plastic knee replacement. </li></ul><ul><li>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 </li></ul>
  17. 18. Classification of Implants Design <ul><li>Unconstrained </li></ul><ul><ul><li>Cruciate retaining </li></ul></ul><ul><ul><li>Cruciate substituting </li></ul></ul><ul><ul><li>Mobile bearing knees </li></ul></ul><ul><li>Constrained (Hinged) </li></ul>
  18. 19. Un constrained TKR
  19. 20. Constrained TKR
  20. 21. Uni condylar TKR
  21. 22. Total Knee Replacement Today <ul><li>Large variety is available </li></ul><ul><li>Majority of TKR today are condylar replacements which consist of the following </li></ul><ul><ul><li>Cobalt-chrome alloy femoral component </li></ul></ul><ul><ul><li>Cobalt-chrome alloy or titanium tibial tray </li></ul></ul><ul><ul><li>UHMWPE tibial bearing component </li></ul></ul><ul><ul><li>UHMWPE patella component </li></ul></ul>
  22. 23. Who Is A Candidate For TKR <ul><li>Quality of life severely affected </li></ul><ul><li>Daily pain </li></ul><ul><li>Restriction of ordinary activities </li></ul><ul><li>Evidence of significant radiographic changes of the knee </li></ul>
  23. 24. What Is The Time For Replacement <ul><li>Old age with more sedentary life style </li></ul><ul><li>Young patients who have limited function </li></ul><ul><li>Progressive deformity </li></ul><ul><li>Other treatment modalities have failed </li></ul><ul><li>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 </li></ul>
  24. 25. Evaluation Of Patient Before Surgery <ul><li>A Complete Medical History </li></ul><ul><li>Thorough Physical Examination </li></ul><ul><li>Laboratory Work-up </li></ul><ul><li>Anesthesia Assessment </li></ul>
  25. 26. Recommended Preoperative Radiographs in Knee Replacement Surgery <ul><li>Standing full-length anteroposterior radiograph </li></ul><ul><li>from hip to ankle </li></ul><ul><li>Lateral knee x ray </li></ul><ul><li>Merchant’s view </li></ul>
  26. 27. Goal of TKR <ul><li>Pain relief </li></ul><ul><li>Restoration of normal limb alignment </li></ul><ul><li>Restoration of a functional range of motion </li></ul>
  27. 28. Successful Results Depends upon: <ul><li>Precise surgical technique </li></ul><ul><li>Sound implant design </li></ul><ul><li>Appropriate material </li></ul><ul><li>Patient compliance with rehabilitation </li></ul>
  28. 29. Technical Goals Of Knee Replacement Surgery <ul><li>The restoration of mechanical alignment, </li></ul><ul><li>Preservation (or restoration) of the joint line, </li></ul><ul><li>Balanced Ligaments </li></ul><ul><li>Maintaining or restoring a normal Q angle. </li></ul>
  29. 30. Mechanical Alignment <ul><li>TKA aims at restoring the mechanical axis of the lower limb by: </li></ul><ul><ul><li>Sequential soft tissue releases </li></ul></ul><ul><ul><li>Correction of bone defects by grafts or prosthetic augments </li></ul></ul>
  30. 31. 4. Ligament Balancing <ul><li>a. Coronal Plane </li></ul><ul><ul><li>For varus deformities’ </li></ul></ul><ul><ul><li>For valgus deformities </li></ul></ul><ul><li>b. Sagittal Plane </li></ul><ul><ul><li>Flexion contractures </li></ul></ul><ul><ul><li>Extension contractures </li></ul></ul>
  31. 32. Procedure
  32. 33. Procedure
  33. 34. Procedure
  34. 35. Procedure
  35. 36. Procedure
  36. 37. Procedure
  37. 38. Procedure
  38. 42. Post Operative Rehabilitation <ul><ul><li>Rapid post-operative mobilization </li></ul></ul><ul><li>Range of motion exercises started </li></ul><ul><li>CPM </li></ul><ul><li>Passive extension by placing pillow under foot </li></ul><ul><li>Flexion- by dangling the legs over the side of bed </li></ul><ul><li>Muscle strengthening exercises </li></ul><ul><li>Weight bearing is allowed on first post op day </li></ul>
  39. 43. Prosthesis Survival <ul><li>Different studies shows different results </li></ul><ul><li>Ranawat et al ( Clin Orthop Relat Res  ) 95% at 15 years </li></ul><ul><li>91% at 21 years </li></ul><ul><li>Gill and Joshi ( Am J Knee Surg ) 96% at 15 years </li></ul><ul><li>82% at 23 years </li></ul><ul><li>Font-Rodriguez ( Clin Orthop Relat Res  ) 98% at 14 years </li></ul>
  40. 44. Ward Data <ul><li>Total no of TKR done in last one year: 8 cases </li></ul><ul><li>Gender: Male ……. 5 cases </li></ul><ul><li>Female….. 3 cases </li></ul><ul><li>Age range: 40…….65 years </li></ul><ul><li>Cause for which TKR done: Osteoarthritis </li></ul><ul><li>Bilateral/Unilateral: Single case for which bilateral knee replacement was done. </li></ul>
  41. 45. Case 1
  42. 47. Case 1
  43. 52. Case 2
  44. 60. Case 3
  45. 66. Case 5
  46. 80. Thanks