total knee replacement (tkr)

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Total Knee Replacement (TKR) Dr Shams ur Rehman Wazir PG Trainee Orthopedics B Unit Hayatabad Medical Complex Peshawar, Pakistan drshamswazir@yahoo.com

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overview Anatomy of the knee joint Common conditions leading to TKR Evolution of TKR Total knee replacement Our own data

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Anatomy Of The Knee Joint Three bones and three compartment

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Knee Stabilizers Midial Lateral Anterior Posterior Rotatory

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Common Conditions That Lead To TKR OSTEOARTHRITIS Primary (idiopathic) Secondary Post traumatic arthritis RHEUMATOID ARTHRITIS

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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

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Risk Factors Of Osteoarthritis Increasing age Obesity Female sex Trauma Infection Repetitive occupational trauma

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Clinical Features Of Osteoarthritis Depends upon stage of involvement Pain Loss of function Stiffness Swelling Deformity Crepitus

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Radiological Features

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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 Corticoteroids Intra articular Hyaluronic acid

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Operative Treatment Arthroscopy Osteotomy Knee replacement surgery

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Arthroscopic Debridement

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Osteotomy

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Knee Replacement Partial knee replacement Total knee replacement

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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

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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

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

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Un constrained TKR

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Constrained TKR

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Uni condylar TKR

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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

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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

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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

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Evaluation Of Patient Before Surgery A Complete Medical History Thorough Physical Examination Laboratory Work-up Anesthesia Assessment 25

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Recommended Preoperative Radiographs in Knee Replacement Surgery Standing full-length anteroposterior radiograph from hip to ankle Lateral knee x ray Merchant’s view

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Goal of TKR Pain relief Restoration of normal limb alignment Restoration of a functional range of motion

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

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Technical Goals Of Knee Replacement Surgery The restoration of mechanical alignment, Preservation (or restoration) of the joint line, Balanced Ligaments Maintaining or restoring a normal Q angle.

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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

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4. Ligament Balancing a. Coronal Plane For varus deformities’ For valgus deformities b. Sagittal Plane Flexion contractures Extension contractures

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Procedure

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Procedure

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Procedure

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Procedure

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Procedure

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Procedure

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Procedure

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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

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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

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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.

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Case 1

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Case 1

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Case 2

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Case 3

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Case 5

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Thanks

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	drshamswazir@yahoo.com 2 Years ago.



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