Total knee arthroplasty l.jpg
Sponsored Links
This presentation is the property of its rightful owner.
1 / 67

Total Knee Arthroplasty PowerPoint PPT Presentation

  • Updated On :
  • Presentation posted in: General

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.

Download Presentation

Total Knee Arthroplasty

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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

Total knee arthroplasty l.jpg

Total Knee Arthroplasty


Dr. Rami Eid

Introduction l.jpg


  • 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 l.jpg

Indications for Knee Arthroplasty

Indications for tka l.jpg

Indications for TKA

  • Relieve pain caused by osteoarthritis of the knee (the most common).

  • Deformity in patients with variable levels of pain:

    • Flexion contracture > 20 degrees.

    • Severe varus or valgus laxity.

Osteoarthritis l.jpg


  • American College of Rheumatology classification criteria:

    Knee pain and radiographic osteophytes and at least 1 of the following 3 items:

    • Age >50 years.

    • Morning stiffness <=30 minutes in duration.

    • Crepitus on motion.

Contraindications for tka l.jpg

Contraindications for TKA

  • Recent or current knee sepsis.

  • Remote source of ongoing infection.

  • Extensor mechanism discontinuity or severe dysfunction.

  • Painless, well functioning knee arthrodesis.

  • Poor health or systemic diseases (relative contraindications).

Unicondylar knee arthroplasty l.jpg


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

Patellar resurfacing l.jpg

Patellar Resurfacing

  • Indication for leaving the patella unresurfaced:

    • Congruent patellofemoral tracking.

    • Normal anatomical patellar shape.

    • No evidence of crystalline or inflammatory arthropathy.

    • Lighter patient.

Classification l.jpg


Classification10 l.jpg




1- Cruciate retaining

2- Cruciate substituting

3- Mobile bearing

4- Unicondylar



Biomechanics of knee arthroplasty l.jpg

Biomechanics of Knee Arthroplasty

Kinematics l.jpg


  • The TRIAXIAL motion of the knee:

    • Articular geometry

    • Ligamentous restraints

Degrees of freedom l.jpg

Degrees of Freedom

Degrees of freedom14 l.jpg

Degrees of Freedom

  • Constrained Prostheses

  • Non-constrained Prostheses

  • Intermediated Prostheses

Constrained prostheses l.jpg

Constrained Prostheses

  • Hinged implants.

  • One degree of freedom.

Non constrained prostheses l.jpg

Non-constrained Prostheses

  • Ideal implants.

  • 5 degrees of freedom.

  • Intact ligamentous system.

Intermediated prostheses l.jpg

Intermediated Prostheses

  • Anterior-posterior stability.

  • Two types:

    • FREEMAN (a cylinder in a non conforming trough).

    • INSALL (posterior stabilized knee).

Intermediated prostheses18 l.jpg

Intermediated Prostheses



Longitudinal alignment of knee l.jpg

Longitudinal Alignment Of Knee

  • Tibial components are implanted perpendicular to the mechanical axis.

  • Femoral component is implanted in 5 – 6 degrees of valgus.

Longitudinal alignment of knee20 l.jpg

Longitudinal Alignment Of Knee

  • Posterior tibial tilt is about 5 – 7 degrees.

  • Usually depend on the articular design.

Anatomic tilt 5 degrees

Rotational alignment of knee l.jpg

Rotational Alignment Of Knee

  • Create a rectangular flexion space.

  • External rotation of the femoral component 3 degrees.

Role of pcl femoral roll back l.jpg

Role of PCL – Femoral Roll-Back

Role of pcl femoral roll back23 l.jpg

Role of PCL – Femoral Roll-Back

Pcl retention or pcl substitution l.jpg

PCL retaining prostheses:

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 ?

Pcl retention or pcl substitution25 l.jpg

PCL-retention or PCL-substitution ?

Pcl retention or pcl substitution26 l.jpg

PCL-retention or PCL-substitution ?

Patella clunk syndrome l.jpg

Patella Clunk Syndrome

Patellofemoral joint l.jpg

Patellofemoral Joint

  • The patella acts to lengthen extensor lever arm.

  • This arm is greatest at 20 degrees of flexion.

Patellofemoral joint29 l.jpg

Patellofemoral Joint

  • Changes in the patellar area of contact can leads to eccentric loading of the patellofemoral joint.

Patellofemoral joint30 l.jpg

Patellofemoral Joint

  • Limb with larger Q angle has a greater tendency for lateral subluxation.

  • Preventing subluxation:

    • Prosthetic component.

    • Vastus medialis (in early flexion).

Polyethylene issues l.jpg

Polyethylene Issues

1- Dished polyethylene avoids the edge loading. (as PCL substitution)

2- Minimal polyethylene thickness >= 8 mm to avoid higher contact stress.

Surgical technique for primary tka l.jpg

Surgical Technique for Primary TKA

Preoperative evaluation l.jpg

Preoperative Evaluation

  • Soft tissue defects around the knee.

  • Vascular status to the limb.

  • Extensor mechanism.

  • Preoperative range of motion.

  • Standing (AP) view, a lateral view of the knee, and a skyline view of the patella.

Surgical preparation l.jpg

Surgical Preparation

  • Administer a dose of a 1st generation cephalosporin (or vancomycin, clindamycin)

  • Avoid pressure on peripheral nerves.

Surgical approaches l.jpg

Surgical Approaches

  • Medial parapatellar retinacular approach.

  • Subvastus approach.

  • Midvastus approach.

Surgical approaches36 l.jpg

Subvastus approach:

Intact extensor mechanism.

Decreasing pain.

More limited.

Postoperative hematoma.

Midvastus approach:

Preserve genicular a. to the patella.

Contraindication in limited preoperative flexion.

Postoperative hematoma.

Surgical Approaches

Surgical approaches37 l.jpg

Surgical Approaches

  • Lateral parapatellar retinacular approach:

    • In valgus knees.

    • Improve patellar tracking and ligamentous balancing.

Bone preparation im femoral guide l.jpg

Bone Preparation – IM Femoral Guide

Bone preparation gap technique l.jpg

Bone Preparation – Gap Technique

Bone preparation tibial resection l.jpg

Bone Preparation – Tibial Resection

  • The guide is aligned with the anterior tibial tendon and first web space of the toes.

Balancing of the knee l.jpg

Balancing of The Knee

Varus deformity l.jpg

Varus Deformity

  • 1st Osteophytes must be removed.

  • 2nd Release the deep MCL.

  • 3rd Release semimembranosus and pes anserinus insertion.

  • 4th release posterior capsule and PCL.

Varus deformity43 l.jpg

Varus Deformity

Valgus deformity l.jpg

Valgus Deformity

  • 1st Remove all osteophytes.

  • 2nd release lateral capsule.

  • 3rd

    • Lesser deformity: release Iliotibial band.

    • Greater deformity: release LCL +/- PCL.

  • Valgus deformity + flexion contracture >> release posterior capsule.

Valgus deformity45 l.jpg

Valgus Deformity

Flexion contracture l.jpg

Flexion Contracture

  • Extension gap < Flexion gap >> more distal femoral bone cut, posterior capsule release.

  • Flexion gap < Extension gap >> larger tibial insert.

Flexion extension balancing l.jpg

Flexion – Extension Balancing

Computer assisted surgery in total knee arthroplasty l.jpg

Computer Assisted Surgery in Total Knee Arthroplasty

Management of bone deficiency l.jpg

Management of Bone Deficiency

Patellofemoral tracking l.jpg

Patellofemoral Tracking

  • Internal rotation of tibial component increases the tendency to lateral patellar subluxation.

  • Prosthetic patella should be medially positioned.

Postoperative management l.jpg

Postoperative Management

Roentgenographic evaluation l.jpg

Roentgenographic Evaluation

Total knee replacement exercise protocol l.jpg

Total knee replacement exercise protocol

  • Postoperative day 1

    • Bedside exercises (e.g. ankle pumps, quadriceps exercises…)

  • Postoperative day 2

    • Exercises for active ROM and terminal knee extension

    • Gait training with assistive device

  • Postoperative day 3-5

    • Progression of ambulation on level surfaces and stairs (if applicable)

  • Postoperative day 5 to 4 weeks

    • Stretching of quadriceps and hamstring muscles

    • Progression of ambulation distance

Specific disorders l.jpg

Specific Disorders

Previous hto l.jpg

Previous HTO

  • Difficult surgical exposure.

  • Lateral ligamentous laxity.

  • Difficult stem placement.

  • Patella infera.

Previous patellectomy l.jpg

Previous Patellectomy

  • PCL retaining arthroplasty for better results.

Complications of total knee arthroplasty l.jpg

Complications of Total Knee Arthroplasty

  • Thromboembolism.

  • Infection.

  • Neurovascular complications.

  • Patellofemoral complications.

  • Periprosthetic fractures.

Patellofemoral complications l.jpg

Patellofemoral Complications

  • Patella clunk syndrome.

  • Patellar component failure.

  • Rupture of patellar ligament.

Periprosthetic fractures l.jpg

Periprosthetic Fractures

Thank you l.jpg


Mokazem com l.jpg

  • هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي.

  • الموقع غير مسؤول عن الأخطاء الواردة في هذه المحاضرة.

  • This lecture is one of a series of lectures were prepared and presented by residents in the department of orthopedics in Damascus hospital, under the supervision of Dr. Bashar Mirali.

  • This site is not responsible of any mistake may exist in this lecture.

Dr. Muayad Kadhim

د. مؤيد كاظم

  • Login