total knee replacement (tkr) ppt
TRANSCRIPT
Dr Shams ur Rehman WazirPG Trainee Orthopedics B Unit
Hayatabad Medical ComplexPeshawar, Pakistan
overview
Anatomy of the knee jointCommon conditions leading to TKREvolution of TKRTotal knee replacementOur own data
Anatomy Of The Knee JointThree bones and three compartment
Knee StabilizersMidial Lateral Anterior Posterior Rotatory
Common Conditions That Lead To TKROSTEOARTHRITIS
Primary (idiopathic)Secondary
Post traumatic arthritisRHEUMATOID ARTHRITIS
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
Risk Factors Of Osteoarthritis
Increasing ageObesityFemale sexTraumaInfectionRepetitive occupational trauma
Clinical Features Of OsteoarthritisDepends upon stage of involvement
I. PainII. Loss of functionIII. StiffnessIV. SwellingV. DeformityVI. Crepitus
Radiological Features
Non Operative Treatment Non pharmacologic therapy
Patient’s educationUse of assistive devicesWeight lossPhysical therapyOccupational therapy
Pharmacologic therapyNSAIDSGlucosamine sulphateIntra articular CorticoteroidsIntra articular Hyaluronic acid
Operative Treatment
Arthroscopy OsteotomyKnee replacement surgery
Arthroscopic Debridement
Osteotomy
Knee ReplacementPartial knee replacementTotal knee replacement
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
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
Classification of Implants Design
Unconstrained Cruciate retainingCruciate substitutingMobile bearing knees
Constrained (Hinged)
Un constrained TKR
Constrained TKR
Uni condylar TKR
Total Knee Replacement TodayLarge variety is availableMajority of TKR today are condylar
replacements which consist of the followingCobalt-chrome alloy femoral componentCobalt-chrome alloy or titanium tibial trayUHMWPE tibial bearing componentUHMWPE patella component
Who Is A Candidate For TKR
Quality of life severely affectedDaily painRestriction of ordinary activitiesEvidence of significant radiographic changes
of the knee
What Is The Time For ReplacementOld age with more sedentary life styleYoung patients who have limited functionProgressive deformityOther treatment modalities have failedTKR 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
Evaluation Of Patient Before SurgeryEvaluation Of Patient Before Surgery
A Complete Medical HistoryThorough Physical ExaminationLaboratory Work-up Anesthesia Assessment
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Recommended Preoperative Radiographs in Knee Replacement Surgery
1. Standing full-length anteroposterior radiographfrom hip to ankle
1. Lateral knee x ray 2. Merchant’s view
Goal of TKR
Pain reliefRestoration of normal limb alignmentRestoration of a functional range of motion
Successful Results Depends upon:
Precise surgical techniqueSound implant designAppropriate materialPatient compliance with rehabilitation
Technical Goals Of Knee Replacement Surgery
1. The restoration of mechanical alignment, 2. Preservation (or restoration) of the joint
line,3. Balanced Ligaments4. Maintaining or restoring a normal Q angle.
Mechanical AlignmentTKA aims at restoring the mechanical axis of the lower limb by:
Sequential soft tissue releasesCorrection of bone defects by grafts or prosthetic augments
4. Ligament Balancinga. Coronal Plane
For varus deformities’For valgus deformities
b. Sagittal PlaneFlexion contracturesExtension contractures
Procedure
Procedure
Procedure
Procedure
Procedure
Procedure
Procedure
Post Operative RehabilitationRapid post-operative mobilizationRange of motion exercises startedCPMPassive extension by placing pillow under
footFlexion- by dangling the legs over the side of
bedMuscle strengthening exercisesWeight bearing is allowed on first post op day
Prosthesis Survival
Different studies shows different resultsRanawat et al (Clin Orthop Relat Res )
95% at 15 years 91% at 21 yearsGill and Joshi (Am J Knee Surg) 96% at 15
years 82% at 23 yearsFont-Rodriguez (Clin Orthop Relat Res )
98% at 14 years
Ward DataTotal no of TKR done in last one year: 8
casesGender: Male ……. 5 cases Female….. 3 casesAge range: 40…….65 years Cause for which TKR done: OsteoarthritisBilateral/Unilateral: Single case for which
bilateral knee replacement was done.
Case 1
Case 1
Case 2
Case 3
Case 5