Life expectancy is increasing, Patients are becoming more obese, increasing the demands on the implants, Replacements done 20 years or earlier are all coming back for revision and We have too many choices for implants and thus often make wrong choices. Indian knees are anatomically different from Caucasean counterparts. As squatters, our hips are often spared the ordeal of primary OA, which we well compensate by the high incidence of OA knees. The demands and expectations of our patients differ considerably from their western counterparts This paper is an attempt to address these problems

1. Dr L.Prakash M.S.
(orth), MCh (orth)

16.  Can this surgery be done in smaller
district level hospitals??

25.  Medial
tibiofemoral
 Lateral
tibiofemoral
 Patellofemoral

48.  Measurement of
actual bones 640
 Anthropometric
measurements 8400
knees (4200
patients)
 Radiological
measurement of
1300 Radiographs
 Total knee joints
measured 10340
640
8400
1300
Data
Osteology
Radiograp
hy
Clinical

49. FEMORAL CONDYLE
 Mediolateral dimensions
 Anterioposterior dimension of medial condyle
 Anterioposterior dimension of lateral condyle
 Femoral valgus/varus

50. UPPER TIBIA
 Mediolateral dimension
 Medial anterioposterior dimension
 Lateral Anterioposterior dimension
 Tibial varus/valgus

52. LOWER FEMORAL DIMENSIONS WITH
SPREAD
 Mediolateral 64.5 to 91.2
 So Femoral component should be available in
53mm, 56mm 59mm 62mm 64mm 67mm 70mm
and 75mm medio-lateral dimensions.
0 20 40 60 80 100
1
46
91
136
181
226
Mediolateral
Numbers

53. So Femoral component should be available in
50mm, 53mm, 56mm 58mm 59mm 63mm 66mm and
70mm AP dimensions.
0
20
40
60
80
100
1
17
33
49
65
81
97
113
129
145
161
177
193
209
225
241
257
inmm
Femur AP
Numbers
Anterioposterior

54. UPPER TIBIAL DIMENSIONS WITH SPREAD
 Mediolateral 54.2 to 81.2mm and thus the tibial trays
should be available in 55mm, 60mm, 63mm, 66mm,
71mm, 75mm and 81mm
0
20
40
60
80
100
1
13
25
37
49
61
73
85
97
109
121
133
145
157
169
181
193
205
217
229
241
253
265
M-Ldimension
Tibial dimensions

55. 0
10
20
30
40
50
60
70
80
1
11
21
31
41
51
61
71
81
91
101
111
121
131
141
151
161
171
181
191
201
211
221
231
241
251
261
271
Numbers
Anterioposterior

56.  Should match dimensions of Indian Knees
 Should be available in a wide range
 Should be an anatomic model with separate
left and right components

57.  Should be available in both mobile and fixed
bearings
 Should be available in both cruciate
sacrifycing and retaining versions.

58.  Should be available in both cemented and
uncemented versions
 Should come with simple instrumentation
capable of giving precise cuts even in the
hands of the beginners

59.  Should have an excellent ligament balancing
system
 Should have a large number of tibial
bearings in small thickness increments

60.  The system should be modular with primary,
revision and resection implants
 Tibial metal-backs should come with medial
and lateral wedges for bone defects

61.  Should use ISO standard cobalt chrome castings
and Virgin non irradiated UHMWUHDPE
 Should be manufactured to ISO, USFDA and CE
standards
 Should be affordable

62. 

63.  Dimensional studies followed by polymer
clay models

80.  8 left 8 right PCL sacrificing posterior
stabilized femoral components
 8 left and 8 right PCL retaining minimally
constrained femoral components
 ( both of above in cemented and cementless
porous coated architecture)

81.  7 tibial trays for fixed HDPE bearing
 7 tibial trays for mobile bearing
 Our knees will have 7 into 8 i.e. 56 HDPE
inserts, either fixed or mobile, in small
increments
 Sizes will be 7,8,9,10.11.12.13.15,17mm
 Patella, nonmetal backed will come in six
sizes 26.29.32.35.38 and 41

82.  1, Is it affordable?
 2, Can it be done in district hospitals?
 3, Is it time tested with clinical data?
 4, How soon will it be available and at what
cost?

83.  This is what it costs to cast two components
in stainless steel 316 L

84.  With HDPE components the production cost
after QC, regulations, approvals and
sterilization will be about Rs 10,000.00 Rs or
$150 US
 So the sale price would be about Rs 15000- or
225 US$
 But will such a versatile knee sell at this
ridiculous cost??

85.  Even a poor patient does not want a cheap
product
 Cheap has become synonymous with sub
standard.
 Even today for our own use we buy branded
medicines at four times, rather than risking
the generic ones
 So a cheap implant is not the answer.

86.  Giving the best value for money to the surgeon
and the best implant to the patient should be the
key
 The better the protocols, more stringent the
quality control and better the implant tractability,
more expensive the manufacturing process
becomes.
 So a good affordable Indian Knee with its
versatile range should sell between 30K to 50K
depending on type. Even at 50k (750$) a
cementless knee is far far cheaper than it is in
USA.

87.  It certainly can be done in a simple AC clean
theater with no infection risks, provided the
OT is prepared properly and the correct
protocol is followed.
 It can certainly done in most district hospitals
with a little extra care. ( after all I have
operated in close to 89 operation theaters
around the world without complications)

88.  Pain and loss of function are the prime
indications and thus patient selection is
subjective.
 In those below 55 with good bone stock, a
cementless knee has to be used
 Above this age, in view of bone stock and
longevity, a cemented knee is preferred.
 Unless the PCL is frayed or torn, retain it and
use a CR component

89.  Mobile bearings offer slightly better results
than fixed bearings in the short term, but they
have not been with us long enough for proper
comparison.
 Soft tissue releases and ligament balance is
the most important factor for long term
success of the operation
 Perfect bone cuts and exact placement of the
components is the key to long lasting success

90. Properly
performed,
TKR is one
of the most
satisfying
surgical
procedures
.

91. Choose the right
patient, plan
the surgery
properly, be
familiar with
the
instruments
and have the
complete
range of
implants with
you