Knee Trauma and Degeneration Resulting in Total Knee ArthroplastyJack D. Lennox, D.O. Chairman, Dept. of Orthopedic Surgery Botsford Hospital

Knee Jointy A diarthrodial joint lined

with articular cartilage and lubricated with synovial fluid

Knee JointLigaments ACL, PCL, MCL, LCLMeniscus Medial & Lateral

Osteoarthritisy Loss of articular cartilage

to bare bone associated with symptomatic inflammation secondary to trauma, birth, malalignment and/or wear over time.

Osteoarthritis

Osteoarthritis

Osteoarthritis Treatment Optionsy Rest y Exercise strength, y Injections

maintenance of motion, aerobic conditioning, etc. y Medications NSAIDs, steroids, glucosamine/chondroitin sulfate, alternative (cherry extract, MSM)

corticosteroids, viscosupplementation (hyaluronic acid Supartz, Synvisc, Euflexxa, etc.) y Electrical Stimulation Bionicare

Osteoarthritis Treatment Options

Osteoarthritis Treatment Optionsy Surgical -

Arthroscopic meniscoplasty and debridement

Osteoarthritis Treatment Optionsy Surgical

Joint resurfacing OATS (Osteochondral Autograft Transfer System)

Osteoarthritis Treatment Optionsy Surgical

Joint Resurfacing ACI ( Autologous Chondrocyte Implantation)

Osteoarthritis Treatment Optionsy Surgical

Osteotomy malalignment Varus bow-legged Valgus knocked-kneed Femoral or Tibial

Osteoarthritis Treatment Optionsy Surgical - Joint Replacement or Arthroplasty

Unicompartmental, Bi-modular, Total Metal Titanium, CrCO ( Porous or Cemented) Plastic Polyethylene, UHMW

Osteoarthritis Treatment Options

Osteoarthritis Treatment Options

Post Surgical TKAy 2-3 days in hospital y 2 weeks walker or crutches y 2 weeks cane y 3 weeks blood thinner, cant drive y 3-4 weeks - first follow-up in office y 8-12 weeks formal physical therapy home & out-pt. y 8-16 weeks RTW no restrictions

Results Total Knee Arthroplastyy 98-99 % - little or no pain @ 2 years post-op y 90% - in and functioning @ 20 years post-op (revision-10%) y 0.5-1.0 % infection rate y 2-4 % blood clot (DVT) y CMS highest rated elective surgery in USA y Why did I wait so long? - most common comment post-op

Factors Affecting Success - TKAy Body Habitus y Deformity y Pre-Op Loss of Motion/Tightness y Number of Surgeries y Co-Morbidities Diabetes, Vascular, Heart y Motivation y Post-op Complications (DVT, Swelling, Infection, Medical

Issues) y Scarring y Workers Compensation

The Case (T.T.)y 6/84 33 y.o. male working for Consumers Power, twisting

y y

y y

injury L knee, arthroscopic surgery, symptoms cured. Probably removed cartilage (meniscus) 7/96 subsequent incidental injury 12/12/05 fell into 3 foot hole in ground covered up by snow. Jammed and twisted L knee with immediate pain and swelling 1/4/06 initial treatment- physical therapy, off work, NSAIDs 1/25/06 symptoms unchanged, MRI ordered

The Case (T.T.)y 2/9/06 MRI positive (meniscus tear), discussed TKA and

pre-op work-up y 3/9/06 Surgery scheduled, . osteoarthritic changes from original incident in 1984 related need for TKA to December 2005 injury y 4/12/06 TKA performed y 4/17/06 Venous duplex ultrasound ordered negative also concern for infection

The Case (T.T.)y 6/15/06 Mild decreased ROM, manipulation under

anesthesia (MUA) scheduled y 7/10/06 RTW without restrictions y 7/19/06 Last note available doing well, ROM 5-105 y 9/06 Voluntary retirement form work

Object - TKAy To provide a stable, pain-free, well-functioning joint

with minimal bone resection and trauma that lasts a lifetime. In other words, essentially GOOD AS NEW.

Post ScriptLaws that cover workers injuries and subsequent treatment for those injuries (especially joint replacement) need to keep up with the times and factor in the vast medical and surgical advancements that have taken place in the last several decades.

Thank You