1. Total Knee Replacement
BRINA, PAIGE, TYLER, & EMANUEL

2. Did you know…?
Walking generates a force of up
to 3x the body weight upon the
knee.
Running can produce a force of
10x the body weight upon the
knee.
Going down stairs can put 5x
the force of normal body
weight on knees.

3. The Knee
 The knee is the largest
and most complex joint
in the human body.
 Hinge joint- only one
direction of movement.
 Some rotation is also
permitted.

4. Bony
Anatomy
 Knee joint
 Femur
 Tibia
 Fibula
 Patella

5. Soft Tissue Anatomy
 Articular Cartilage
 Menisci- absorb shock
 Lateral Collateral Ligament & Medial
Collateral Ligament- stability
 Anterior Cruciate Ligament & Posterior
Cruciate Ligament- stability
 Synovial Fluid- lubricates the joint to
eliminate friction

6. Cartilage
Breakdown
 Intact cartilage allows
knee to function with
smooth motion.
 Breakdown results in
narrowing of joint space,
bone spurs, and/or
damage to surrounding
soft tissue structures.

7. What caused the
joint to become
diseased?
 Osteoarthritis
 Rheumatoid
arthritis

8. Osteoarthritis
 Normal wear and tear of a
joint.
 Causes:
 Age
 Injury
 Weight
 Stress on joint
 Poorly formed joint

9. Rheumatoid Arthritis
 Chronic inflammatory
disorder that affects the
joints.
 Autoimmune
 Risk factors:
 Age
 Sex
 Family History

10. What can be done for the knee?
 Indications for a total knee
arthroplasty are:
 To eliminate or reduce
pain
 Improve functional
activities
 Correct deformity
Contraindications include:
Active or recent septic
arthritis
A “nonfunctioning
extensor mechanism or
severe neurologic
dysfunction that
prevents extension or
control of the knee
Neuropathic joint

11. Preparing for surgery
o Pre-Operative Evaluation
o Pre-Admission Testing
o Scheduling of Surgery
o Medication Adjustments
o X-Rays, possibly an MRI
o Anesthesiology Preparation
o Option for Blood Banking
o Education on TKR
o Muscle Strengthening
o Mental Preparation

12. Surgical Procedure
 A vertical incision is
made down the knee to
gain access to the
surgery site.
 For a traditional surgery
= 8-10 inches long
 The patella is exposed
 The surgeon rotates the
patella away from the
knee to enable admission
to the inner tissue of the
knee.

13. Surgical Procedure
 Femur is exposed and surgeon is able to carefully
remove the area of damaged bone and cartilage.
 Once the bone is resurfaced, the surgeon fits the
metal femoral component of the implant.
 Cementless = porous-coated and allows
surrounding bone to grow into and adhere to
prosthesis (direct biologic fixation).
 Cement = most common due to better survival =
~15 years
 Hybrid = advancing approach- cemented tibial
component, noncemented femoral component
 Young, active patients at highest risk for
component loosening.

14. Surgical Procedure
 The tibia is rid of all damaged
bone and cartilage.
 The surgeon fits the plastic and
metal tibial components.
 The tibial tray is fitted to the
tibia (usually using bone
cement).
 Polyethylene insert is placed
between femur and tibia to act
as a buffered articulating
surface and to provide support.

15. Surgical Procedure
 Before replacing the
original patella, the
surgeon may cement
an additional
component to the
backside of it in
order to ensure a
proper fit with the
rest of the implant.

16. Total Knee Replacement= Total Knee
Arthroplasty

17. Possible Complications
Side effects from anesthesia
Blood clots
Infection
Complications from a transfusion
Allergy to metal components
Wound and bleeding complications
Nerve or neurovascular damage
Knee stiffness or loss of motion
Prosthesis problems and implant
failure

18. Outcomes of Surgery
 99.96% of patients
survive this surgery.
 84% are living 10
years after the
surgery.
 1% get a
postoperative
infection.
 Less than 2% acquire
blood clots.
 About 85% of
implants still work
after 20 years.

19. Prognosis
 Most people who undergo a
TKR are between the ages of
50-80 years, with the average
being about 70 years of age.
 Short-term results are excellent.
Most patients can stand, with
limited weight-bearing, the day
after surgery.
 With exercise, maintaining a
healthy weight, protection
against infection, and
avoidance of high impact
sports, long-term results are
optimal.