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Dr Surendra OjhaAssociate Professor
MPT Ortho/MusculosketetalMGUMST JAIPUR
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� Anatomy of the knee joint� Common conditions leading to TKR� Evolution of TKR� Total knee replacement� Our own data
Anatomy Of The Knee Joint� Three bones and three compartment
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 ArthritisKnee Arthritis
� Far more common than hip OA in asian population
� Age: 80% above 75 years
� Sex: Equal in both sexes upto 45 -55 yearsAfter 55 years more common in female
Risk Factors Of OsteoarthritisRisk Factors Of Osteoarthritis
� Increasing age� Obesity� Female sex� Trauma� Infection� Repetitive occupational trauma
Clinical Features Of Osteoarthritis� Depends upon stage of involvement
I. PainII. Loss of functionIII. StiffnessIV. SwellingV. DeformityVI. Crepitus
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� Glucosamine sulphate� Intra articular Corticoteroids� Intra articular Hyaluronic acid
Operative Treatment
� Arthroscopy � Osteotomy� Knee replacement surgery
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Arthroscopic DebridementArthroscopic Debridement OsteotomyOsteotomy
Knee Replacement� Partial knee replacement� Total 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
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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 patellafemur, tibia and patella
Classification of Implants Design
� Unconstrained � Cruciate retaining� Cruciate substituting� Mobile bearing knees
� Constrained (Hinged)
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Un constrained TKRUn constrained TKR Constrained TKRConstrained TKR
Uni condylar TKR 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
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 atrophyatrophy
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Evaluation Of Patient Before SurgeryEvaluation Of Patient Before Surgery
� A Complete Medical History� Thorough Physical Examination� Laboratory Work-up� Anesthesia Assessment
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Recommended Preoperative Radiographs in Knee Replacement SurgeryKnee Replacement Surgery
1. Standing full-length anteroposterior radiographfrom hip to ankle
1. Lateral knee x ray 2. Merchant’s view
Goal of TKR
� Pain relief� Restoration of normal limb alignment� Restoration of a functional range of motion
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
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 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 Balancing4. Ligament Balancing� a. Coronal Plane
� For varus deformities’� For valgus deformities
� b. Sagittal Plane� Flexion contractures� Extension contractures
ProcedureProcedure
Procedure Procedure
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Procedure Procedure
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ProcedureProcedure ProcedureProcedure
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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 SurvivalProsthesis Survival
Different studies shows different results� Ranawat et al ( Clin Orthop Relat Res )
95% at 15 years91% at 21 years
� Gill and Joshi (Am J Knee Surg)96% at 15 years82% at 23 years
� Font-Rodriguez (Clin Orthop Relat Res )98% at 14 years
Ward DataWard 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.
Case 1
Case 1
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