Knee Arthroplasty Lee W. Hash, M.D. Affinity Orthopedics & Sports Medicine 1531 S. Madison Street, Appleton
Knee Arthroplasty Lee W. Hash, M.D.
Affinity Orthopedics & Sports Medicine
1531 S. Madison Street, Appleton
Lee W. Hash, MD
• BA, 1984 - Luther College, Decorah, IA
• MD, 1988 - U of Iowa, Iowa City, IA
• Orthopedic Residency 1993- Albany,
NY
• USAF Orthopedic Surgeon 1993-1999
• Private Practice 1999-2006- Scottsbluff,
NE
• Affinity Medical Group 2006- present-
Appleton, WI
Knee Replacement Surgery
• 1996-2002 200% Increase in TKR
• 500,000 TKR in 2005
• 3.5 million/year by 2030 projected
What Causes Knee Joint Pain?
•One of the most common causes of joint
pain is arthritis. The most common types of
arthritis are:
– Osteoarthritis (OA)
– Rheumatoid Arthritis (RA)
– Post-traumatic Arthritis
– Osteonecrosis •Normal knee •Diseased knee
Osteoarthritis (OA)
• Also called arthritis, degenerative joint
disease, wear & tear arthritis
• >20 million Americans
• Characterized by joint pain associated with
injury, overuse and increasing age
• Two general features:
– Loss of articular cartilage
– Formation of bone spurs
Osteoarthritis (OA)
• Clinically marked by
– “Achy” joint pain
– End of day stiffness
– Swelling
– Difficulty arising from a seated position
• OA becomes nearly universal by age 70
• Most commonly effects the knees, hips
fingers, and spine
Risk Factors for Osteoarthritis (OA)
• Joint stress = Load x Activity
– Fractures
– Family History
– Overweight
– Natural problems of joint alignment
– Women > Men
Osteoarthritis (OA)
• Progresses slowly
– Ache after physical work or exercise
– Pain, sometimes steady
– Tenderness near the joint
– “Crunching” feeling when used (crepitus)
– Difficulty climbing in & out of chairs, cars, bath
tub
9
Menomonie, WI
Treatment Options
Education
Activity Modification
Exercise
Weight Loss
Bracing (Neoprene, Ace)
Thermal therapies
Pool Therapy
Nutraceuticals
Tylenol
Creams (ie capsaicin)
NSAIDs
Cortisone injections
Hyaluronate injections
Surgical options:
-Arthroscopy
-Osteotomy
-Partial replacement
-Total knee
replacement
Surgery
• Arthroscopic surgery
– A knee “scope”
• Osteotomy
– A knee realignment procedure
– Better in younger patients
• Partial joint replacement
– Most effective early in disease
• Total joint replacement
– Complete replacement of the knee joint with metal & plastic
TKR
• Preop and postop expectations
• What is done
• What has changed
• Recovery time
Benefits of Knee Replacement
• Pain Relief
• Improved Walking
• Less Knee Stiffness
• Improved Leg Alignment
Results of Knee Replacement
0
20
40
60
80
100
Pain Relief Improved
Motion
Normal
Walk
Improved
Align
Pain Relief Improved Motion Normal Walk Improved Align
%
Knee Replacement
Surgical Procedure
• Patient is anesthetized
• Incision is made
• Arthritic surface at the end of the thigh
bone or femur is removed
• Bone is prepared for a new covering
• Femoral component is attached
Source: www.Jointreplacement.com, 2003
Surgical Procedure
• Tibial surface is resected
• Patella is prepared
• Components are “trialed”
• Final components are cemented in place
• Incision is closed
Total Knee Joint Replacement
– End surface of femur
replaced with metal
– End surface of tibia
replaced with metal
– Plastic liner is
inserted between
femur and tibia to
reduce wear
– Patella is resurfaced
with plastic
TKR
• Design of components
– Radius of curvature
• “round” Knee
• Gender specific
– PCL retention vs sacrifice
– Mobile vs fixed bearing
Rotating platform
TKR
• Polyethylene
– Delamination
– Sterilization
– Crosslinking
– Conformity
TKR – Surgical
• Computer assisted surgery
• Robotic assisted surgery
• Custom TKR cutting blocks
• Surgical approach
• Post-operative
Normal Knee X-ray Arthritic Knee X-ray
Replaced Knee X-ray
Anterior View Lateral View
Unicompartmental Replacement
TKR Recovery
• Hospital stay 2-3 days
• Therapy- ROM, strength, edema control
• Off work 2-3 months
• Gradual improvement 6-12 months
Knee Surgery
•May be suitable for patients who:
– Have a painful, disabling joint disease of the
knee resulting from a severe form of arthritis
– Are not likely to achieve satisfactory results from
less invasive procedures, medication, physical
therapy, or joint fluid supplements
Complications of Knee
Replacement
3 0.5 3 2
0
20
40
60
80
100
Blood
Clots
Infection Motion
Problems
Wound
Healing
Blood Clots Infection Motion Problems Wound Healing
Other Rare Complications
• Death
• Infection
• Sciatica
• Dislocation
• Phlebitis
• Nerve Injury
• Deep Vein Thrombosis
• Bone Fractures
• Hemorrhage
• Loosening of Implant
• Leg Length Inequality
• Knee Instability
33
34
Summary
Osteoarthritis (OA) is characterized by
joint pain associated with injury,
overuse and increasing age.
Best when recognized early.
Summary
Early: activity modification, exercise
Bracing
Nutraceuticals?
Tylenol, NSAIDs
Summary
Cortisone & Hyaluronate injections
Arthroscopy
Osteotomy
Partial or Total joint replacement
Summary
Joint Camp at St. Elizabeth Hospital
• Pre-Op Teaching: PACE
• An organized Joint Camp group teaching once weekly in the
Helen Fowler Conference Room
• Centralized outpatient labs/EKG/radiology
• Medical clearance
• Designate a “coach,” to be present at Joint Camp
• Consider post-op plans
Affinity Joint Camp
40
Thank You
Lee W. Hash, M.D.
Affinity Orthopaedics & Sports Medicine
1531 S. Madison Street, Appleton
(920) 996-3700
42