Dr Neelam Venkatramana Reddy is one of the best orthopedic doctors in Hyderabad with extensive experience in the area of joint replacement for a span of fifteen years. Visit: www.neelamramanareddy.com

1. Total Knee Replacement (TKR)
Dr Neelam Venktramana Reddy
www.neelamramanareddy.com

2. Overview
01
02
03
04
Anatomy of the knee joint
Common conditions leading toTKR
Evolution of TKR
Total knee replacement

3. Anatomy of the Knee

4. Knee Stabilizers
 Medial
 Lateral
 Anterior
 Posterior
 Rotatory

5. CommonConditions That LeadToTKR
01
02
Osteoarthritis
Rheumatoid Arthritis
Primary (idiopathic)
Secondary Post traumatic arthritis
i
ii

6. Knee Arthritis
 Far more common than hip OA in Asian population
 Age: 80% above 75years
 Genders: Equal in both genders up to 45-55 years. After 55 years
more common infemales

7. Risk Factors of Osteoarthritis
 Increasing age
 Obesity
 Females
 Trauma
 Infection
 Repetitive Occupational Trauma

8. ClinicalFeaturesOfOsteoarthritis
Depends upon the stage of involvement
 Pain
 Loss of Function
 Stiffness
 Swelling
 Deformity
 Crepitus

9. Non Operative Treatment
 Non-pharmacologic therapy
 Patient’s education
 Use of assistive devices
 Weight loss
 Physical therapy
 Occupational therapy
 Pharmacologic therapy
 NSAIDS
 Glucosamine sulphate
 Intra articular Corticosteroids
 Intra articular Hyaluronicacid

10. OperativeTreatment
 Arthroscopy
 Osteotomy
 Knee replacement surgery

11. Osteotomy

12. Knee Replacement
 Total knee replacement
 Partial knee replacement

13. Evolution of TKR
 Fergussen (1860) resection arthroplasty
 Verneuil performed first interposition arthroplasty
 1940s- first artificial implants were tried whenmolds were fitted in
thefemoral condyle
 1950s- combined femoral and tibial articular surface replacement
appeared as simplehinges

14. Evolution of TKR (count)
 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 3 components
which would resurface on all the three surfaces of the knee – the femur,
tibia and patella

15. Classification of Implants Design
 Unconstrained
 Cruciate retaining
 Cruciate substituting
 Mobile bearing knees
 Constrained (Hinged)

16. Total Knee Replacement Today
 Large variety is available
 Majority of TKRstoday are condylar replacements
which consist of the following:
 Cobalt-chrome alloy femoral component
 Cobalt-chrome alloy or titanium tibialtray
 UHMWPE tibial bearing component
 UHMWPE patella component

17. 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

18. Time For Replacement
 Old age with moresedentary life style
 Young patients who have limitedfunctions
 Progressive deformity
 Other treatment modalities havefailed
 TKRs should be done before things get out of hands and
the patient experiences a severe decrease in ROM,
deformity, contracture, joint instability or muscle atrophy

19. Evaluation Of Patient Before Surgery
 AComplete Medical History
 Thorough Physical Examination
 Laboratory Work-up
 Anesthesia Assessment

20. Goal of TKR
 Pain relief
 Restoration of normal limb alignment
 Restoration of a functional range ofmotion

21. Successful Results Depends upon:
 Precise surgical technique
 Sound implant design
 Appropriate material
 Patient compliance with rehabilitation

22. Technical Goals Of TKR Surgery
 The restoration of mechanical alignment.
 Preservation (or restoration) of thejoint line,
Balanced Ligaments
 Maintaining or restoring a normal Q angle.

23. 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

24. Ligament Balancing
a.Coronal Plane
For varus deformities’
For valgus deformities
b. SagittalPlane
Flexion contractures
Extension contractures

25. Post-Operative Rehabilitation
 Rapid post-operative mobilization
 Range of motion exercises started
 CPM
 Passive extension by placing pillow underfoot
 Flexion-by dangling the legs over the side of bed
 Muscle strengthening exercises
 Weight bearing is allowed on first post op day

26. Total Knee Replacement (TKR)
By Dr. Neelam Venktramana Reddy
Dr. N eelam Venkatramana Reddy is one of the leading Orthopaedic Surgeons in Hyderabad with extensive
experience in the area of joint replacement for a span of fifteen years.
15+
Years Experience
22K+
Satisfied Patients
11K+
Surgeries
Book An Appointment Now ! Call us on: 040 44 777 777

27. www.neelamramanareddy.com