1. knee arthroplasty in osteoarthritis
Ghaem.Int. Hospital Oct.2017
Mehran Soleymanha (Ass. Prof. GUMS , Knee surgery fellowship)

2. History The development of TKA began in the early 1970s
about 20,000 TKA procedures each year
second most common arthroplasty after total hip arthroplasty
The prosthesis choice varies depending on:
underlying disease
severity of knee joint damage
age of the patient
Skou T, et al. A Randomized, Controlled Trial of Total Knee Replacement. The New England Journal of Medicine. 2015

4. Indication Painful severe osteoarthritis
Painful osteonecrosis with sub-chondral collapse of a condyle
Moderate painful osteoarthritis with progressive deformity
Sébilo et al. Clinical and technical factors influencing outcomes of unicompartmental knee arthroplasty: Retrospective multicentre study of 944 knees. Orthopaedics & Traumatology: Surgery & Research

5. Absolute Contraindications
Recent Knee Sepsis
Extensor mechanism discontinuity or dysfunction
Painless, Well functioning Knee Arthrodesis
Mills WJ , et al. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004

6. Relative contraindications
Medical conditions compromising patient’s ability to withstand anesthesia, metabolic demands of surgery and wound healing
Severe atherosclerotic disease of operative leg
Skin conditions such as psoriasis within operative field
Venous stasis disease with recurrent cellulitis
Morbid obesity
Osteomyelitis in proximity of knee
Recurvatum deformity secondary to muscle weakness
Gademan MG, et al. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-thescience overview. BMC Musculoskeletal Disorders 2016.

7. 10-20% very poor or no improvement following TKA
Inappropriate expectations
contralateral knee pain
higher psychological distress
high body mass index
advanced age
female gender
lower OA grade
Raynauld, et al. Total Knee Replacement as a Knee Osteoarthritis Outcome: Predictors Derived from a 4-Year Long-Term Observation following a Randomized Clinical Trial Using Chondroitin Sulfate. Cartilage

8. UKA minimally invasive approach less blood loss
easier recovery of muscle damage
De Jesus, et al. Evaluation of a Patient Decision Aid for Unicompartmental or Total Knee Arthroplasty for Medial Knee Osteoarthritis. J Arthroplasty. 2017

9. UKA
Indications:
knee osteoarthritis involving a single femoro-tibial compartment with a functioning anterior cruciate ligament (ACL)
Contraindicated:
Knee ligamentous instability
Sever mal alignment
BMI > 30
Inflammatory knee arthritis
Palumbo et al . Diagnosis and Indications for Treatment of Unicompartmental Arthritis. Clin in Sport Med. 2014

10. Primary prosthesis

11. L.C.C.K prosthesis

13. hinged prosthesis Indications: Extensor mechanism failure
Severe recurvatum instability

14. Prosthesis survival risk factors: anterior femoral notching
osteoporosis
rheumatoid arthritis
steroid use
female gender
revision arthroplasty
neurological disorders
In young patients, the higher demands result in a greater risk of wear
Castagnini , et al. Total Knee Replacement in Young Patients: Survival and Causes of Revision in a Registry Population. The Journal of Arthroplasty

15. Causes of failure infection Sepsis Component loosening
Instability / ligamentous laxity
Polyethylene wear with osteolysis
Periprosthetic fractures
Patellofemoral complications
Lungu et al. Prediction of poor outcomes six months following total knee arthroplasty in patients awaiting surgery.. BMC Musculoskeletal Disorders 2014

16. better outcomes Select patients carefully based on their: age
Activities
knee function
degree of osteoarthritis
Improvements in polyethylene quality
greater implant position accuracy
Sébilo et al. Clinical and technical factors influencing outcomes of unicompartmental knee arthroplasty: Retrospective multicentre study of 944 knees. Orthopaedics & Traumatology: Surgery & Research

17. Thank you