knee arthroplasty in osteoarthritis Ghaem Int Hospital MEHRAN

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knee arthroplasty in osteoarthritis Ghaem. Int. Hospital MEHRAN SOLEYMANHA FELLO WS HIP) 19. Oct.

knee arthroplasty in osteoarthritis Ghaem. Int. Hospital MEHRAN SOLEYMANHA FELLO WS HIP) 19. Oct. 2017 ( ASS. PROF. GU MS , KNEE SUR GERY

History • The development of TKA began in the early 1970 s • about

History • The development of TKA began in the early 1970 s • 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 of the patient Skou T, et al. A Randomized, Controlled Trial of Total Knee Replacement. The New England Journal of Medicine. 2015

Indication • Painful severe osteoarthritis • Painful osteonecrosis with sub-chondral collapse of a condyle

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. 2013

Absolute Contraindications • Recent Knee Sepsis • Extensor mechanism discontinuity or dysfunction • Painless,

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

Relative contraindications • Medical conditions compromising patient’s ability to withstand anesthesia, metabolic demands of

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.

10 -20% very poor or no improvement following TKA § Inappropriate expectations § contralateral

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. 2013.

UKA • minimally invasive approach • less blood loss • easier recovery of muscle

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

UKA Indications: knee osteoarthritis involving a single femoro-tibial compartment with a functioning anterior cruciate

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

Primary prosthesis

Primary prosthesis

L. C. C. K prosthesis

L. C. C. K prosthesis

hinged prosthesis Indications: • Extensor mechanism failure • Severe recurvatum instability

hinged prosthesis Indications: • Extensor mechanism failure • Severe recurvatum instability

Prosthesis survival risk factors: • • anterior femoral notching osteoporosis rheumatoid arthritis steroid use

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. 2017

Causes of failure • infection • Sepsis • Component loosening • Instability / ligamentous

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

better outcomes • Select patients carefully based on their: • age • Activities •

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. 2013

Thank you

Thank you

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