6. Common Conditions That Lead To TKR
OSTEOARTHRITIS
Primary (idiopathic)
Secondary
Post traumatic arthritis
RHEUMATOID ARTHRITIS
7. 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
8. Risk Factors Of Osteoarthritis
Increasing age
Obesity
Female sex
Trauma
Infection
Repetitive occupational trauma
9. Clinical Features Of Osteoarthritis
Depends upon stage of involvement
I. Pain
II. Loss of function
III. Stiffness
IV. Swelling
V. Deformity
VI. Crepitus
16. 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
17. 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
18. Classification of Implants
Design
Unconstrained
Cruciate retaining
Cruciate substituting
Mobile bearing knees
Constrained (Hinged)
22. 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
23. 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
24. 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
atrophy
25. Evaluation Of Patient Before Surgery
Evaluation Of Patient Before Surgery
A Complete Medical History
Thorough Physical Examination
Laboratory Work-up
Anesthesia Assessment
25
26. Recommended Preoperative Radiographs in
Knee Replacement Surgery
1. Standing full-length anteroposterior radiograph
from hip to ankle
3. Lateral knee x ray
4. Merchant’s view
27. Goal of TKR
Pain relief
Restoration of normal limb alignment
Restoration of a functional range of motion
29. Technical Goals Of Knee Replacement Surgery
O The restoration of mechanical alignment,
o Preservation (or restoration) of the joint line,
Balanced Ligaments
t Maintaining or restoring a normal Q angle.
30. 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
31. 4. Ligament Balancing
a. Coronal Plane
For varus deformities’
For valgus deformities
b. Sagittal Plane
Flexion contractures
Extension contractures
42. 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
43. Prosthesis Survival
Different studies shows different results
Ranawat et al (Clin Orthop Relat Res )
95% at 15 years
91% at 21 years
Gill and Joshi (Am J Knee Surg)
96% at 15 years
82% at 23 years
Font-Rodriguez (Clin Orthop Relat Res )
98% at 14 years
44. Ward 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.
