Total Knee Arthroplasty. 06/06/2006. Dr. Rami Eid. Introduction. TKA is one of the most successful and commonly performed orthopedic surgery. The best results for TKA at 10 – 15 yrs. compare to or surpass the best result of THA. Indications for Knee Arthroplasty. Indications for TKA.
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Dr. Rami Eid
Knee pain and radiographic osteophytes and at least 1 of the following 3 items:
Younger patients with unicompartmental disease instead of HTO.
Elderly thin patient with unicompartmental disease (shorter rehabilitation, greater ROM)
Flexion contracture >= 5 degrees.
ROM < 90 degrees.
Angular deformity >= 15 degrees.
Cartilaginous erosion in the weight-bearing area of the opposite compartment.Unicondylar Knee Arthroplasty
1- Cruciate retaining
2- Cruciate substituting
3- Mobile bearing
Anatomic tilt 5 degrees
Better ROM (roll-back, flat tibial surface).
More symmetrical gait (stair climbing).
Less femoral bone resection is required.
PCL needs to be accuracy balanced.
PCL substituting prostheses:
Easier surgical exposure.
See-saw effect prevention.
Lower tibial polyethylene contact stress
Posterior tibial component displacement.
Patella clunk syndrome.PCL-retention or PCL-substitution ?
1- Dished polyethylene avoids the edge loading. (as PCL substitution)
2- Minimal polyethylene thickness >= 8 mm to avoid higher contact stress.
Intact extensor mechanism.
Preserve genicular a. to the patella.
Contraindication in limited preoperative flexion.
Postoperative hematoma.Surgical Approaches
Dr. Muayad Kadhim
د. مؤيد كاظم