Total Knee Replacement in Arthritis - Current Concepts
Pp. 105-127 (23)
Total knee replacement is one of the most successful and cost-effective
interventions in the modern medicine for the treatment of pain caused by advanced
arthritis of the knee. Great advances have been made in the last five decades in the
mechanical properties and the design of the knee implants, surgical techniques and
prevention of complications. Both cruciate-retaining and sacrificing designs are widely
used with the proponents of both the designs. More constrained designs are used in
complex primary and in revision cases. Pain affecting the activities of daily living in an
elderly person suffering from severe osteoarthritis is the commonest indication for a
primary total knee arthroplasty followed by rheumatoid arthritis. Current or recent
infection is an absolute contraindication for a knee replacement. Most commonly the
procedure is performed through a midline longitudinal incision and a medial
parapatellar arthrotomy. Recent advances include computer aided navigation (has
shown to improve the component positioning), gender specific knee (better choice of
component sizes) and patient specific instrumentation (to improve the accuracy of bone
resection). Long term results and cost effectiveness of these techniques remain
unproven. Infection (1-3%) is the most common and serious complication followed by
thromboembolism, instability, and neurovascular injury.
Knee implants, Osteoarthritis, Primary knee replacement, Revision
knee arthroplasty, Rheumatoid arthritis, Surgical treatment of arthritis, Total knee
arthroplasty, Total knee designs, Total knee replacement.
Fortis Hospital, Banneragatta Road, Bengaluru, India.