TKA Indications Pain and disfunction severe enough to justify surgery Pain and disfunction severe enough to justify surgery X-ray correlation: joint damage.

TKATKAIndicationsIndications

• Pain and disfunction severe Pain and disfunction severe enough to justify surgeryenough to justify surgery• X-ray correlation: joint damage X-ray correlation: joint damage

beyond repair by other meansbeyond repair by other means• Patient good understanding of Patient good understanding of

what to expect from surgery what to expect from surgery

TOTAL KNEE REPLACEMENTTOTAL KNEE REPLACEMENTWhen?When?

• PainPain• FunctionFunction• LOMLOM• Level of disabilityLevel of disability

TOTAL KNEE REPLACEMENTTOTAL KNEE REPLACEMENTHow?How?

• FixationFixationCementCementCementlessCementless

• Incision – approachIncision – approachLimited – minimalLimited – minimal

• Prosthetic choiceProsthetic choice

TKATKAThings to considerThings to consider

• Patient’s agePatient’s age• Occupation and activity levelOccupation and activity level• Surgeon abilitySurgeon ability• Patient desires Patient desires

TKATKATYPESTYPES

• UnicompartmentalUnicompartmental• TricompartmentalTricompartmental

- Posterior cruciate retaining- Posterior cruciate retaining- Posterior cruciate substituting- Posterior cruciate substituting

• HingeHinge

UNICOMPARTMENTALUNICOMPARTMENTAL• Medial-lateralMedial-lateral

Single comp. DiseaseSingle comp. DiseaseGood ligamentsGood ligamentsLimited activityLimited activity

• PatellofemoralPatellofemoralOnly PF diseaseOnly PF diseaseNo patellar maltrackingNo patellar maltrackingFew candidatesFew candidates

TKATKATYPESTYPES

TricompartmentalTricompartmental• Non modularNon modular• Modular Modular • Rotating platformRotating platform

TOTAL KNEE ARTHROPLASTYTOTAL KNEE ARTHROPLASTYSurgerySurgery

• 1-2 hr surgery1-2 hr surgery• 3-5 days hospitalization3-5 days hospitalization• More discomfort than hipMore discomfort than hip• Rehabilitation a bit harderRehabilitation a bit harder

TOTAL KNEE ARTHROPLASTYTOTAL KNEE ARTHROPLASTYAnesthesiaAnesthesia

• Regional or generalRegional or general• Femoral n. block (continuous)Femoral n. block (continuous)

Sciatic n. blockSciatic n. block postop analgesiapostop analgesia

forfor

TOAL KNEE ARTHROPLASTYTOAL KNEE ARTHROPLASTYRecoveryRecovery

• 4-6 wks walker / 2 crutches4-6 wks walker / 2 crutches• Wait for wound healing to FWBWait for wound healing to FWB• Physical therapy advisablePhysical therapy advisable

TOTAL KNEE ARTHROPLASTYTOTAL KNEE ARTHROPLASTYExpectationsExpectations

• 95% satisfaction95% satisfaction• Slightly less than THASlightly less than THA• 20+ yrs longevity20+ yrs longevity• Ability to walk distancesAbility to walk distances• Bike, horseback riding: Bike, horseback riding: yesyes• Skiing, running, jumping: Skiing, running, jumping: nono

TOTAL JOINT ARTHROPLASTYTOTAL JOINT ARTHROPLASTYMinimally Invasive SurgeryMinimally Invasive Surgery

• Same surgery, smaller incisionSame surgery, smaller incision• Technically more demandingTechnically more demanding• No proofs that recovery is No proofs that recovery is

better, faster or less painfulbetter, faster or less painful• No long-term dataNo long-term data

TOTAL JOINT REPLACEMENTTOTAL JOINT REPLACEMENTHIP AND KNEEHIP AND KNEE

ConclusionsConclusions

• Pain relieving and function Pain relieving and function improving proceduresimproving procedures

• Predictable resultsPredictable results

TOTAL JOINT REPLACEMENTTOTAL JOINT REPLACEMENTHIP AND KNEEHIP AND KNEE

Who Should Do It?Who Should Do It?

• Proper trainingProper training• Over 50/yrOver 50/yr