TKA Indications Pain and disfunction severe enough to

TKA Indications • Pain and disfunction severe enough to justify surgery • X-ray correlation: joint damage beyond repair by other means • Patient good understanding of what to expect from surgery

TOTAL KNEE REPLACEMENT When? • • Pain Function LOM Level of disability

TOTAL KNEE REPLACEMENT How? • Fixation Cementless • Incision – approach Limited – minimal • Prosthetic choice

TKA Things to consider • Patient’s age • Occupation and activity level • Surgeon ability • Patient desires

TKA TYPES • • • Unicompartmental Tricompartmental - Posterior cruciate retaining - Posterior cruciate substituting Hinge

UNICOMPARTMENTAL • Medial-lateral Single comp. Disease Good ligaments Limited activity • Patellofemoral Only PF disease No patellar maltracking Few candidates

TKA TYPES Tricompartmental • • • Non modular Modular Rotating platform

TOTAL KNEE ARTHROPLASTY Surgery • • 1 -2 hr surgery 3 -5 days hospitalization More discomfort than hip Rehabilitation a bit harder

TOTAL KNEE ARTHROPLASTY Anesthesia • Regional or general • Femoral n. block (continuous) Sciatic n. block postop analgesia for

TOAL KNEE ARTHROPLASTY Recovery • • • 4 -6 wks walker / 2 crutches Wait for wound healing to FWB Physical therapy advisable

TOTAL KNEE ARTHROPLASTY Expectations • • • 95% satisfaction Slightly less than THA 20+ yrs longevity Ability to walk distances Bike, horseback riding: yes Skiing, running, jumping: no

TOTAL JOINT ARTHROPLASTY Minimally Invasive Surgery Same surgery, smaller incision Technically more demanding No proofs that recovery is better, faster or less painful • No long-term data • • •

TOTAL JOINT REPLACEMENT HIP AND KNEE Conclusions • Pain relieving and function improving procedures • Predictable results

TOTAL JOINT REPLACEMENT HIP AND KNEE Who Should Do It? • Proper training • Over 50/yr