TKA Indications Pain and disfunction severe enough to justify surgery Pain and disfunction severe...
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Transcript of TKA Indications Pain and disfunction severe enough to justify surgery Pain and disfunction severe...
TKATKAIndicationsIndications
• Pain and disfunction severe Pain and disfunction severe enough to justify surgeryenough to justify surgery• X-ray correlation: joint damage X-ray correlation: joint damage
beyond repair by other meansbeyond repair by other means• Patient good understanding of Patient good understanding of
what to expect from surgery what to expect from surgery
TOTAL KNEE REPLACEMENTTOTAL KNEE REPLACEMENTWhen?When?
• PainPain• FunctionFunction• LOMLOM• Level of disabilityLevel of disability
TOTAL KNEE REPLACEMENTTOTAL KNEE REPLACEMENTHow?How?
• FixationFixationCementCementCementlessCementless
• Incision – approachIncision – approachLimited – minimalLimited – minimal
• Prosthetic choiceProsthetic choice
TKATKAThings to considerThings to consider
• Patient’s agePatient’s age• Occupation and activity levelOccupation and activity level• Surgeon abilitySurgeon ability• Patient desires Patient desires
TKATKATYPESTYPES
• UnicompartmentalUnicompartmental• TricompartmentalTricompartmental
- Posterior cruciate retaining- Posterior cruciate retaining- Posterior cruciate substituting- Posterior cruciate substituting
• HingeHinge
UNICOMPARTMENTALUNICOMPARTMENTAL• Medial-lateralMedial-lateral
Single comp. DiseaseSingle comp. DiseaseGood ligamentsGood ligamentsLimited activityLimited activity
• PatellofemoralPatellofemoralOnly PF diseaseOnly PF diseaseNo patellar maltrackingNo patellar maltrackingFew candidatesFew candidates
TKATKATYPESTYPES
TricompartmentalTricompartmental• Non modularNon modular• Modular Modular • Rotating platformRotating platform
TOTAL KNEE ARTHROPLASTYTOTAL KNEE ARTHROPLASTYSurgerySurgery
• 1-2 hr surgery1-2 hr surgery• 3-5 days hospitalization3-5 days hospitalization• More discomfort than hipMore discomfort than hip• Rehabilitation a bit harderRehabilitation a bit harder
TOTAL KNEE ARTHROPLASTYTOTAL KNEE ARTHROPLASTYAnesthesiaAnesthesia
• Regional or generalRegional or general• Femoral n. block (continuous)Femoral n. block (continuous)
Sciatic n. blockSciatic n. block postop analgesiapostop analgesia
forfor
TOAL KNEE ARTHROPLASTYTOAL KNEE ARTHROPLASTYRecoveryRecovery
• 4-6 wks walker / 2 crutches4-6 wks walker / 2 crutches• Wait for wound healing to FWBWait for wound healing to FWB• Physical therapy advisablePhysical therapy advisable
TOTAL KNEE ARTHROPLASTYTOTAL KNEE ARTHROPLASTYExpectationsExpectations
• 95% satisfaction95% satisfaction• Slightly less than THASlightly less than THA• 20+ yrs longevity20+ yrs longevity• Ability to walk distancesAbility to walk distances• Bike, horseback riding: Bike, horseback riding: yesyes• Skiing, running, jumping: Skiing, running, jumping: nono
TOTAL JOINT ARTHROPLASTYTOTAL JOINT ARTHROPLASTYMinimally Invasive SurgeryMinimally Invasive Surgery
• Same surgery, smaller incisionSame surgery, smaller incision• Technically more demandingTechnically more demanding• No proofs that recovery is No proofs that recovery is
better, faster or less painfulbetter, faster or less painful• No long-term dataNo long-term data
TOTAL JOINT REPLACEMENTTOTAL JOINT REPLACEMENTHIP AND KNEEHIP AND KNEE
ConclusionsConclusions
• Pain relieving and function Pain relieving and function improving proceduresimproving procedures
• Predictable resultsPredictable results