TKA Indications Pain and disfunction severe enough to justify surgery Pain and disfunction severe enough to justify surgery X-ray correlation: joint damage beyond repair by other means X-ray correlation: joint damage beyond repair by other means Patient good understanding of what to expect from surgery Patient good understanding of what to expect from surgery

TOTAL KNEE REPLACEMENT When? Pain Pain Function Function LOM LOM Level of disability Level of disability

TOTAL KNEE REPLACEMENT How? Fixation FixationCementCementless Incision – approach Incision – approach Limited – minimal Prosthetic choice Prosthetic choice

TKA Things to consider Patient’s age Patient’s age Occupation and activity level Occupation and activity level Surgeon ability Surgeon ability Patient desires Patient desires

TKA TYPES Unicompartmental Unicompartmental Tricompartmental Tricompartmental - Posterior cruciate retaining - Posterior cruciate substituting Hinge Hinge

UNICOMPARTMENTAL Medial-lateral Medial-lateral Single comp. Disease Good ligaments Limited activity Patellofemoral Patellofemoral Only PF disease No patellar maltracking Few candidates

TKA TYPES Tricompartmental Non modular Non modular Modular Modular Rotating platform Rotating platform

TOTAL KNEE ARTHROPLASTY Surgery 1-2 hr surgery 1-2 hr surgery 3-5 days hospitalization 3-5 days hospitalization More discomfort than hip More discomfort than hip Rehabilitation a bit harder Rehabilitation a bit harder

TOTAL KNEE ARTHROPLASTY Anesthesia Regional or general Regional or general Femoral n. block (continuous) Sciatic n. block Femoral n. block (continuous) Sciatic n. block postop analgesia postop analgesiafor

TOAL KNEE ARTHROPLASTY Recovery 4-6 wks walker / 2 crutches 4-6 wks walker / 2 crutches Wait for wound healing to FWB Wait for wound healing to FWB Physical therapy advisable Physical therapy advisable

TOTAL KNEE ARTHROPLASTY Expectations 95% satisfaction 95% satisfaction Slightly less than THA Slightly less than THA 20+ yrs longevity 20+ yrs longevity Ability to walk distances Ability to walk distances Bike, horseback riding: yes Bike, horseback riding: yes Skiing, running, jumping: no Skiing, running, jumping: no

TOTAL JOINT ARTHROPLASTY Minimally Invasive Surgery Same surgery, smaller incision Same surgery, smaller incision Technically more demanding Technically more demanding No proofs that recovery is better, faster or less painful No proofs that recovery is better, faster or less painful No long-term data No long-term data

TOTAL JOINT REPLACEMENT HIP AND KNEE Conclusions Pain relieving and function improving procedures Pain relieving and function improving procedures Predictable results Predictable results

TOTAL JOINT REPLACEMENT HIP AND KNEE Who Should Do It? Proper training Proper training Over 50/yr Over 50/yr