Total Knee Replacement (TKR) by Dr. Neelam V. Ramana Reddy (1)

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• Total Knee Replacement (TKR)

• Dr Neelam Venktramana Reddy
• www.neelamramanareddy.com

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Overview
01
Anatomy of the knee joint
02
Common conditions leading to TKR
03
Evolution of TKR
04
Total knee replacement
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• Anatomy of the Knee

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• Knee Stabilizers

• Medial
• Lateral
• Anterior
• Posterior
• Rotatory

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• Common Conditions That Lead To T K R

01
Osteoarthritis
Primary (idiopathic)
i
Secondary Post traumatic arthritis
ii
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Rheumatoid Arthritis
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• Knee Arthritis

• Far more common than hip OA in Asian population
• Age 80 above 75 years
• Genders Equal in both genders up to 45-55
  years. After 55 years
• more common in females

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• Risk Factors of Osteoarthritis

• Increasing age
• Obesity
• Females
• Trauma
• Infection
• Repetitive Occupational Trauma

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• Clinical Features Of Osteoarthritis

• Depends upon the stage of involvement
• Pain
• Loss of Function
• Stiffness
• Swelling
• Deformity
• Crepitus

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• Non Operative Treatment

• Non-pharmacologic therapy
• Patients education
• Use of assistive devices
• Weight loss
• Physical therapy
• Occupational therapy
• Pharmacologic therapy
• NSAIDS
• Glucosamine sulphate
• Intra articular Corticosteroids
• Intra articular Hyaluronic acid

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• Operative Treatment

• Arthroscopy
• Osteotomy
• Knee replacement surgery

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• Osteotomy

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• Knee Replacement

• Total knee replacement
• Partial 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 (count)

• 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 3 components which
  would resurface on all the 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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• 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 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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• 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 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

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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 TKR 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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• Ligament Balancing

a. Coronal Plane For varus deformities For
valgus deformities b. Sagittal Plane Flexion
contractures Extension contractures
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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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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
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www.neelamramanareddy.com