Transcript Total Knee Replacement

Michael O. Williams, MD FAAOS
Edmond Orthopedic Group
1
Anatomy of the knee
•
Largest joint in body
•
Referred to as a hinge joint because it allows the knee to
flex & extend; while hinges can only bend and straighten,
the knee has the ability to rotate (turn) & translate (glide)
•
3 bones
• Tibia
• Femur
• Patella
It’s estimated 70 million people in the U.S. have some form
of arthritis.1 Osteoarthritis is one of the most common types.
Osteoarthritis
•
•
Wear and tear that deteriorates the “cushion” in the joints
Traumatic injury to joint surface i.e. fracture or internal
derangement such as meniscus tear that leads to loss of joint
space
Rheumatoid Arthritis
•
An autoimmune disease that attacks the lining
of joints, causing swelling, possibly throbbing pain
and deformity
1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website.
<http://www.ama-assn.org/amednews/2005/05/02/hlsc0502.htm>, 2005.
Healthy knee
The end of each bone in the joint is
covered with cartilage, acting as a cushion
so the joint functions without pain
Diseased knee (osteoarthritis)
Wear and tear deteriorates natural
cushion, leading to bone-on-bone
contact, soreness and swelling
•
Does the knee hurt one or more days per week?
•
Does the pain interfere with sleep?
•
Is it painful for to walk more than a block?
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Are pain medications no longer working?
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Is knee pain limiting participation in activities
(e.g. family vacations or other functions)?
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Has inactivity from knee pain caused weight gain?
•
Rate the pain on a scale of 1 to 5
•
For most people, the tipping point is about 4 or 5—
that’s when the pain becomes too difficult and
they turn to a surgeon for relief1
Little or
no pain
1. 2007 DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study.
Excruciating,
debilitating pain
Check patient’s mobility

If performing any of the movements below, it may be
time to consider some type of medical intervention
Walk
Bend at the
hips and knees
Pretend to drive:
push the gas/brake
Pretend to golf:
swing a club
Water therapy
•
Soaking, ice packs, hot packs
Exercise & physical therapy
•
Also good for weight loss
Medications
Analgesics (non-steroidal anti-inflammatories)
• Corticosteroids (short term)
•
Injections
•
Corticosteroids or
hyaluronic acid preparations
(e.g., ORTHOVISC, HYALGAN, EUFLEXXA,
SYNVISC, SUPARTZ)
 Implants
 Helps
replace damaged surfaces
relieve pain and restore mobility
 Approximately
580,000 knee
replacements are performed each year
in the U.S.1
 One
study has shown that ten years
after surgery, 99.6% of patients still
depend on their SIGMA® Knees with
fixed bearing option in their daily lives2
1. American Association of Orthopaedic Surgeons. Total Knee Replacement – Your Orthopaedic Connection.
http://orthoinfo.aaos.org/topic.cfm?topic=a00389 Accessed April, 2011.
2. Dalury et al. Midterm results with the P.F.C. SIGMA Total Knee Arthroplasty System. The Journal of Arthroplasty
Vol.23, No.2, 2008: 175-181.
A surgical procedure that
removes and replaces
diseased joint surfaces
with implants
Femoral
component
Tibial
component
•
•
•
•
•
Diseased areas at top of shin bone
(tibia) and bottom of thigh bone
(femur) are removed and reshaped
Femoral component covers the
thigh bone (femur)
Tibial component covers the
shin bone (tibia)
Polyethylene insert placed between
femoral and tibial components
Patellar component replaces the
kneecap (patella)
Femoral
component
Polyethylene
insert
Patellar
component
Tibial
component
Healthy knee
Knee replacement
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TKA come in a wide range of shapes, sizes and materials
and can be individualized to the patient
Most TKA systems come in enough sizes to essentially
custom fit the implants to the individual knee
TKAs are available in both fixed bearing designs and
mobile bearing designs
•
•
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Most widely used type of knee
replacement in the U.S. today1
Designed to enhance stability
of the joint
New designs and advanced
materials
- Helps reduce wear
1. IMS Health
Designed to rotate as it bends, imitating your
natural knee movement
• The surfaces of the knee joint roll
and glide against each other as
you bend. In other words, your knee
naturally rotates as it bends
• Designed for patients who want to
remain active since it minimizes
implant wear, compared to traditional
knee replacements1
• One study has shown after 20 years, 97% of
patients still depend on their rotating platform
knees in their daily lives2
1. McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2).” 2003.
2. Buechel F., et al. “Twenty Year Evaluation of Meniscal Bearing and Rotating Platform Knee Replacements.”
Clinical Orthopaedics and Related Research July 2001: 41-50.
Assess pain and ability to function
• Is the knee pain severe? (4-5 of 5)
• Has the pain and loss of function affected quality of life?
• Is it difficult to sleep or perform basic functions (walking, driving,
climbing stairs)?
• Does medication no longer provide relief?
Consult your physician
Early diagnosis and treatment are important1
• Delaying may lower your quality of life2
Osteoarthritis is degenerative—it won’t get
better and may get worse
1. Fortin PR, et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism. 1999;42:1722-1728.
2. Fortin PR, et al. Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients With Osteoarthritis
of the Hip or Knee. Arthritis & Rheumatism. 2002;46:3327-3330.

The leading cause of knee pain is osteoarthritis

Osteoarthritis is degenerative – it won’t get better and may get worse



Early diagnosis and treatment for total knee replacement are
important1
An Arthritis Foundation® study shows total knee replacement has a
90-95% rate of patient satisfaction2
The newer total knees come in a wide range of shapes, sizes and
materials, and have improved longevity over past designs
Arthritis Foundation® is a trademark of The Arthritis Foundation, Inc.
1. Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999): 1722-1728
2. The Arthritis Foundation. <http://arthitis.org/research/Bulletin/vol5no11/Printable.htm>, 2006.