1. A Comparison of TKA and PKA

2. Components for Partial and Total knee surgeries (bonesmart.org)

3. Objectives Define TKA and PKA Advantages/Disadvantages Indications for each procedure Rehabilitation Therapeutic exercises/activities Handout-How we can prepare our patients for more successful recovery/what to expect

4. Brief review of knee surgeries… Currently in the U.S. 15 million people suffer from knee osteoarthritis, from these 600,000 patients will undergo total knee procedures Average age lies between 60-80 years old Approximately two-thirds of the patients are female Advances in knee replacements within the past 30 yrs offer patients with severe knee injury ability to lead reasonable, full and active lives with minimal pain in the knee joint There are dozens of different types of knee replacement prosthesis available Joint prosthesis cost approximately $4,000-$ 6,000 Replacement surgery is successful in 9 out of 10 people Usually infection or loose hardware results in a revision

5. Total knee arthroscopy (TKA) or replacement/resurfacing The traditional procedure for knee pain Major surgery, where diseased parts of the knee are removed and replaced with artificial parts (prosthesis) 8-12 inch cut is made in front of the knee Quadriceps tendon (which is attached to patella) is cut and the patella is turned over and pushed out of the way, or removed and replaced Replacement parts includes a rounded, U-shaped part that fits over the end of the femur or the upper part of the joint, made out of metal. A flatter piece, metal too, is placed on the lower aspect of the knee and has a stem that fits down into the bone Polyethylene plastic is inserted between the two metal portions, keeps the two metal parts from touching Great outcomes- decreased pain in knee when damaged joint is relieved when new gliding surface is constructed Longer hospital stay of 3 – 5 days Considerable pain post-op

6. Limitations to TKA Difficulties with securing hardware long-term with bone loss of patient Implant failure/breakage Infections Osteolysis Early loosening more in cementless TKA Malalignments Fracture Patella maltracking Deep vein thrombosis

7. Post-op care for TKA Movement!!! Extension (optimal is less than or equal to -10) Flexion motions (optimal 80 -100 degrees +) WBAT No ROM limit Watch for acute complications Increased pain, excessive swelling, decrease in muscle function or sensitivity, sudden SOB, persistent drainage or skin infection

8. Partial Knee Arthroscopy (PKA) or Unicompartmental (Uni) One compartment of knee is affected Inlays and onlays are used to conserve diseased part of the joint surface Surgeon reshapes damaged surface before installing hardware (metal and plastic) Patella replacements are considered PKA Smaller incisions, 3-5 inch Less tissue damage (surgeon works between fibers of quadriceps tendon instead of cutting through the tendon) Decreased pain Less blood loss Better motion due to less scar tissue formation Shorter length of hospital stay Shorter recovery rate

9. Limitations of PKA Surgery works if bone has not been damaged by arthritis Requires other side of knee to have healthy cartilage Usually require younger aged patient (under age 60) Procedure not recommended for the following patients: Obese Sedentary Insulin dependant diabetes Osteoporosis RA Bony visualization is limited, which could lead to malalignment of hardware

10. Post-op care for PKA (Follow surgeon protocol) but there are no limitations as far as bending and straightening the knee No weight bearing limits, (as tolerated) Do not overdue movement, can damage knee Treat edema with ice and elevation and moderate rest as needed Physical therapy is recommended, but not as crucial as recovery with TKA

11. Suggested Rehabilitation EARLY ACTIVITY (see Nelson, Krista, Rolayne or Heather ) Depending on surgeon protocol, early activity- Counteracts effects of anesthesia Encourages healing Prevents atrophy of muscles Encourages healthy digestion Patient feels more normal, less restricted Some optimal early exercises- ankle pumps, quad sets, heel slides, SAQ, LAQ and/or CPM use, deep breathing May counteract depression (change in mobility/lifestyle)

12. Rehabilitation cont.. Important to recover strength in operated leg and continue to maintain strength in non-operated leg,other extremities and core due to abnormal gait with limping Address functional movements : Closed chain exercises-squats (on/off toilet, in and out of car, sitting on a chair) Stairs (up with the good, down with the bad) Rolling (bed mobility) Ambulation on uneven surfaces May take up to 6-12 months to restore strength from TKA, shorted for PKA Speed of recovery/rehab depends on patient condition before surgery Suggested low-impact activities: Walking, swimming, golfing, hiking, stationary bike riding pilates

13. We are headed in the right direction… TKA has undergone many advances over the past 20 yrs Revision rates are low Improvements in surgical techniques and materials have led to reliable pain relief for patients Implant survival rate greater than 90-95% at 10 yrs, and approx 80% at 20 yr follow-up Need to continue to understand prosthetic failure and methods for reconstruction in failed knees

14. Bibliography Abraham, TR, Jr., Wright, JT. WebMD. Total Joint Replacement Rehabilitation. April 2012.URL:emedicine.medscape.com/article 320061. November 2012 Kaushik, AP, Scanelli, JA, Quanjun, C MD US Musculoskeletal Review. Advances and Controversies in Total Knee Arthoplasty.Febuary 2011.URL:www.touchmusculoskeletal.com. October 2012 Skawara, A., Tibesku, CO, Rudolf, Reichelt.BMC Musculoskeletal Disorders. Damages of the tibial post constrained total knee prostheses in early postoperative course.June 2008.URL:www.biomedcentral.com. October 2012 www.bonesmart.org. The Foundation for the Advancement in Research in Medicine, Inc. Non Profit.2012 www.bonesmart.org

15. Thank-you! -Heather Boies