A Comparison of TKA and PKA

1. A Comparison of TKA and PKA

2. Components for Partial and Total knee surgeries (bonesmart.org)

3. Objectives • Define TKA and PKA • Advantages/Disadvantages • Indications for each procedure • Rehabilitation • Therapeutic exercises/activities • Handout-How we can prepare our patients for more successful recovery/what to expect

4. Brief review of knee surgeries… • Currently in the U.S. 15 million people suffer from knee osteoarthritis, from these 600,000 patients will undergo total knee procedures • Average age lies between 60-80 years old • Approximately two-thirds of the patients are female • Advances in knee replacements within the past 30 yrs offer patients with severe knee injury ability to lead reasonable, full and active lives with minimal pain in the knee joint • There are dozens of different types of knee replacement prosthesis available • Joint prosthesis cost approximately $4,000-$ 6,000 • Replacement surgery is successful in 9 out of 10 people • Usually infection or loose hardware results in a revision

5. Total knee arthroscopy (TKA) or replacement/resurfacing • The traditional procedure for knee pain • Major surgery, where diseased parts of the knee are removed and replaced with artificial parts (prosthesis) • 8-12 inch cut is made in front of the knee • Quadriceps tendon (which is attached to patella) is cut and the patella is turned over and pushed out of the way, or removed and replaced • Replacement parts includes a rounded, U-shaped part that fits over the end of the femur or the upper part of the joint, made out of metal. A flatter piece, metal too, is placed on the lower aspect of the knee and has a stem that fits down into the bone • Polyethylene plastic is inserted between the two metal portions, keeps the two metal parts from touching • Great outcomes- decreased pain in knee when damaged joint is relieved when new gliding surface is constructed • Longer hospital stay of 3 – 5 days • Considerable pain post-op

6. Limitations to TKA • Difficulties with securing hardware long-term with bone loss of patient • Implant failure/breakage • Infections • Osteolysis • Early loosening more in cementless TKA • Malalignments • Fracture • Patella maltracking • Deep vein thrombosis

7. Post-op care for TKA • Movement!!! • Extension (optimal is less than or equal to -10) • Flexion motions (optimal 80 -100 degrees +) • WBAT • No ROM limit • Watch for acute complications • Increased pain, excessive swelling, decrease in muscle function or sensitivity, sudden SOB, persistent drainage or skin infection

8. Partial Knee Arthroscopy (PKA) or Unicompartmental (Uni) • One compartment of knee is affected • Inlays and onlays are used to conserve diseased part of the joint surface • Surgeon reshapes damaged surface before installing hardware (metal and plastic) • Patella replacements are considered PKA • Smaller incisions, 3-5 inch • Less tissue damage (surgeon works between fibers of quadriceps tendon instead of cutting through the tendon) • Decreased pain • Less blood loss • Better motion due to less scar tissue formation • Shorter length of hospital stay • Shorter recovery rate

9. Limitations of PKA • Surgery works if bone has not been damaged by arthritis • Requires other side of knee to have healthy cartilage • Usually require younger aged patient (under age 60) • Procedure not recommended for the following patients: • Obese • Sedentary • Insulin dependant diabetes • Osteoporosis • RA • Bony visualization is limited, which could lead to malalignment of hardware

10. Post-op care for PKA • (Follow surgeon protocol) but there are no limitations as far as bending and straightening the knee • No weight bearing limits, (as tolerated) • Do not overdue movement, can damage knee • Treat edema with ice and elevation and moderate rest as needed • Physical therapy is recommended, but not as crucial as recovery with TKA

11. Suggested Rehabilitation • EARLY ACTIVITY (see Nelson, Krista, Rolayne or Heather ) • Depending on surgeon protocol, early activity- • Counteracts effects of anesthesia • Encourages healing • Prevents atrophy of muscles • Encourages healthy digestion • Patient feels more normal, less restricted • Some optimal early exercises- ankle pumps, quad sets, heel slides, SAQ, LAQ and/or CPM use, deep breathing • May counteract depression (change in mobility/lifestyle)

12. Rehabilitation cont.. • Important to recover strength in operated leg and continue to maintain strength in non-operated leg ,other extremities and core due to abnormal gait with limping • Address functional movements : • Closed chain exercises-squats (on/off toilet, in and out of car, sitting on a chair) • Stairs (up with the good, down with the bad) • Rolling (bed mobility) • Ambulation on uneven surfaces • May take up to 6-12 months to restore strength from TKA, shorted for PKA • Speed of recovery/rehab depends on patient condition before surgery • Suggested low-impact activities: • Walking, swimming, golfing, hiking, stationary bike riding pilates

13. We are headed in the right direction… • TKA has undergone many advances over the past 20 yrs • Revision rates are low • Improvements in surgical techniques and materials have led to reliable pain relief for patients • Implant survival rate greater than 90-95% at 10 yrs, and approx 80% at 20 yr follow-up • Need to continue to understand prosthetic failure and methods for reconstruction in failed knees

14. Bibliography • Abraham, TR, Jr., Wright, JT. WebMD. Total Joint Replacement Rehabilitation. April 2012.URL:emedicine.medscape.com/article 320061. November 2012 • Kaushik, AP, Scanelli, JA, Quanjun, C MD US Musculoskeletal Review. Advances and Controversies in Total Knee Arthoplasty.Febuary 2011.URL:www.touchmusculoskeletal.com. October 2012 • Skawara, A., Tibesku, CO, Rudolf, Reichelt.BMC Musculoskeletal Disorders. Damages of the tibial post constrained total knee prostheses in early postoperative course.June 2008.URL:www.biomedcentral.com. October 2012 • www.bonesmart.org. The Foundation for the Advancement in Research in Medicine, Inc. Non Profit.2012

15. Thank-you! -Heather Boies