Total knee replacement (tkr) ppt

i prepared this presentation for our hospital monthly clinicopathological conference. our experience with TKR is not so vast but v are satisfied with what v have done till date.

1. Dr Shams ur Rehman Wazir
PG Trainee Orthopedics B Unit
Hayatabad Medical Complex
Peshawar, Pakistan
[email protected]

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

3. Anatomy Of The Knee Joint
Three bones and three compartment

4. Knee Stabilizers
Midial
Lateral
Anterior
Posterior
Rotatory

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

10. Radiological Features

11. 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

12. Operative Treatment
Arthroscopy
Osteotomy
Knee replacement surgery

13. Arthroscopic Debridement

14. Osteotomy

15. Knee Replacement
Partial knee replacement
Total knee replacement

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)

19. Un constrained TKR

20. Constrained TKR

21. Uni condylar TKR

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 SurgeryEvaluation 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

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

29. Technical Goals Of Knee Replacement Surgery
OThe restoration of mechanical alignment,
oPreservation (or restoration) of the joint line,
Balanced Ligaments
tMaintaining 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

32. Procedure

33. Procedure

34. Procedure

35. Procedure

36. Procedure

37. Procedure

38. Procedure

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.

45. Case 1

47. Case 1

52. Case 2

60. Case 3

66. Case 5