Total Knee Arthroplasty
Other Names
- Total Knee Arthroplasty
- Knee Replacement
Background
History
- Modern era of replacements began in the 1950s with the hinged design [1]
- 1970s improvement allowed for rotation at the femur and tibia junction [2]
- This was the origin for the common cruciate retaining (CR) vs posterior stabilizing (PS) types of implants
- 1990s and 2000s began the introduction of computer assisted replacements. [3]
Epidemiology
- In 2012, the United States has the highest incidence rate (IR) of knee arthroplasty worldwide, with 235 procedures/100,000 habitants [4]
- Logistic regression modelling suggests the IR of TKA is expected to increase 69% by 2050 compared to 2012
- Knee Osteoarthritis is the most common indication for TKA. [5]
- Can affect any of the three compartments in the knee
- Over 50% of people over 65 have radiographic changes consistent with osteoarthritis
Anatomy
- Q angle measured through the patella
- Average in males is 13 and females is 9
- Weight Bearing
- Strengthened by
Indications
- Knee Osteoarthritis
- With conconminant valgus alignment
- Less often with varus alignment
- Trauma
Complications
- Periprosthetic Fractures
- Periprosthetic Joint Infections
- Malalignment
- Arthrosis
- Extensor Mechanism Rupture
- Patellar Maltracking
- Stiffness
- Wound Complications
- Vascular Injury
- Common Peroneal Nerve Palsy
- Aseptic Loosening
- Patellar Clunk Syndrome
- Metal Hypersensitivity
Alternatives to TKA Surgery
- High Tibial Osteotomy
- Unicompartmental Arthroplasty
- Knee Arthrodesis
- Weight Loss
- Strength Training
Types of Implants
- Cruciate Retaining (CR)
- PCL is retained
- Posterior Stabilizing (PS)
- Highly Congruent Liner, aka Anterior Stabilizing
Theories of TKA Alignment
- Restoration of Mechanical Alignment
- 0 degree Tibial cut
- Allows for 3 degrees of variability in varus or valgus direction
- Restoration of Kinetic Alignment
- Femur cut in 9 degrees valgus
- Tibial cut in 3 degrees varus
See Also
References
- ↑ Saragaglia, D., Rubens-Duval, B., Gaillot, J., Lateur, G., & Pailhé, R. (2018). Total knee arthroplasties from the origin to navigation: history, rationale, indications. International Orthopaedics, 43(3), 597–604. https://doi.org/10.1007/s00264-018-3913-z
- ↑ Saragaglia, D., Rubens-Duval, B., Gaillot, J., Lateur, G., & Pailhé, R. (2018). Total knee arthroplasties from the origin to navigation: history, rationale, indications. International Orthopaedics, 43(3), 597–604. https://doi.org/10.1007/s00264-018-3913-z
- ↑ Saragaglia, D., Rubens-Duval, B., Gaillot, J., Lateur, G., & Pailhé, R. (2018). Total knee arthroplasties from the origin to navigation: history, rationale, indications. International Orthopaedics, 43(3), 597–604. https://doi.org/10.1007/s00264-018-3913-z
- ↑ Inacio, M. C. S., Paxton, E. W., Graves, S. E., Namba, R. S., & Nemes, S. (2017). Projected increase in total knee arthroplasty in the United States – an alternative projection model. Osteoarthritis and Cartilage, 25(11), 1797–1803. https://doi.org/10.1016/j.joca.2017.07.022
- ↑ Van, M. D., Nace, J., & Mont, M. A. (2012). Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners. PubMed, 112(11), 709–715.
- ↑ Image courtesy of https://www.summitortho.com/
- ↑ Image courtesy of https://www.gponline.com/