1 / 17

knee arthroplasty in osteoarthritis

knee arthroplasty in osteoarthritis. Mehran Soleymanha ( Ass. Prof. GUMS , Knee surgery fellowship). Ghaem.Int. Hospital 19.Oct.2017. History. The development of TKA began in the early 1970s about 20,000 TKA procedures each year

marylong
Download Presentation

knee arthroplasty in osteoarthritis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. knee arthroplasty in osteoarthritis Mehran Soleymanha (Ass. Prof. GUMS , Knee surgery fellowship) Ghaem.Int. Hospital 19.Oct.2017

  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

  3. 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

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. Primary prosthesis

  10. L.C.C.K prosthesis

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

  12. 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

  13. 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

  14. 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

  15. Thank you

More Related