Total Knee Replacement (TKR) by Dr.Neelam Ramana Reddy

Total Knee Replacement (TKR) Dr Neelam Venktramana Reddy www.neelamramanareddy.com

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Anatomy of the knee joint Common conditions leading to TKR Evolution of TKR Total knee replacement

Anatomy of the Knee

Knee Stabilizers  Medial  Lateral  Anterior  Posterior  Rotatory

Common Conditions That Lead To TKR Osteoarthritis

01

Primary (idiopathic)

i

ii

02

Secondary Post traumati c arthriti s

Rheumatoid Arthritis

Knee Arthritis 

Far more common than hip OA in Asian population

 

Age: Genders:

80% above 75 years Equal in both genders up to 45-55 years. After 55 years more common in females

Risk Factors of Osteoarthritis      

Increasing age Obesity Females Trauma Infection Repetitive Occupational Trauma

Clinical Features Of Osteoarthritis Depends upon the stage of involvement  Pain  Loss of Function  Stiffness  Swelling  Deformity  Crepitus

Non Operative Treatment  Non-pharmacologic therapy  Patient’s educati on  Use of assistive devices  Weight loss  Physical therapy  Occupati onal therapy  Pharmacologic therapy  NSAIDS  Glucosamine sulphate  Intra articular Corticosteroids  Intra articular Hyaluronic acid

Operative Treatment   

Arthroscopy Osteotomy Knee replacement surgery

Osteotomy

Knee Replacement ďƒ˜ Total knee replacement ďƒ˜ Partial knee replacement

Evolution of TKR  Fergussen (1860) resecti on arthroplasty  Verneuil performed first interpositi on arthroplasty  1940s- first artificial implants were tried when molds were fi tted in

the femoral condyle

 1950s- combined femoral and tibial arti cular surface replacement

appeared as simple hinges

Evolution of TKR (count) ďƒ˜ Frank Gunston (1971), developed a metal on plastic knee replacement. ďƒ˜ John Insall (1973), designed what has become the prototype for current

total knee replacements. This was a prosthesis made of 3 components which would resurface on all the three surfaces of the knee – the femur, ti bia and patella

Classification of Implants Design  Unconstrained  Cruciate retaining  Cruciate substituting  Mobile bearing knees

 Constrained (Hinged)

Total Knee Replacement Today  Large variety is available  Majority of TKRs today are condylar replacements

which consist of the following:

 Cobalt-chrome alloy femoral component  Cobalt-chrome alloy or ti tanium tibial tray  UHMWPE tibial bearing component  UHMWPE patella component

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

Time For Replacement  Old age with more sedentary life style  Young patients who have limited functions  Progressive deformity  Other treatment modalities have failed  TKRs should be done before things get out of hands and

the pati ent experiences a severe decrease in ROM, deformity, contracture, joint instability or muscle atrophy

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

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

Technical Goals Of TKR Surgery  The restoration of mechanical alignment.  Preservation (or restoration) of the joint line,

Balanced Ligaments  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

Ligament Balancing a. Coronal Plane For varus deformities’ For valgus deformities

b. Sagittal Plane Flexion contractures Extension contractures

Post-Operative Rehabilitation  Rapid post-operative mobilization  Range of moti on 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

15+ Years Experience

22K+ Satisfied Patients

11K+ Surgeries

Total Knee Replacement (TKR)

By Dr. Neelam Venktramana Reddy Dr. N eelam Venkatramana Reddy is one of the leading Orthopaedic Surgeons in Hyderabad with extensive experience in the area of joint replacement for a span of fifteen years.

Book An Appointment Now ! Call us on: 040 44 777 777

www.neelamramanareddy.com