Scribd
Upload
72 views27 pages

Group Members Habiba Jameel Raffia Tariq Amina Zahoor Zunaira

This document provides information about total knee replacement surgery. It discusses the types of knee replacements, components of knee implants, surgical procedures, rehabilitation protocols, risks, and precautions. Key points include that total knee replacement replaces the thigh bone, shin bone, and sometimes kneecap surfaces with prosthetics to relieve pain from arthritis. Rehabilitation involves exercises to improve range of motion and strength over several weeks.

Uploaded by

Muiz Saddozai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
72 views27 pages

Group Members Habiba Jameel Raffia Tariq Amina Zahoor Zunaira

This document provides information about total knee replacement surgery. It discusses the types of knee replacements, components of knee implants, surgical procedures, rehabilitation protocols, risks, and precautions. Key points include that total knee replacement replaces the thigh bone, shin bone, and sometimes kneecap surfaces with prosthetics to relieve pain from arthritis. Rehabilitation involves exercises to improve range of motion and strength over several weeks.

Uploaded by

Muiz Saddozai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 27

GROUP MEMBERS

HABIBA JAMEEL
RAFFIA TARIQ
AMINA ZAHOOR
ZUNAIRA
TOTAL KNEE
REPLACEMENT
DEFINITION
 It is a surgical procedure to replace the weight-
bearing surfaces of the knee joint to relieve
pain and disability.
 TKA consists of resection of the diseased
articular surfaces of the knee, followed by
resurfacing with metal and polyethylene
prosthetic components
TYPES
 The four main types of knee replacement surgery are:
 total knee replacement
 unicompartmental (partial) knee replacement
 kneecap replacement (patellofemoral arthroplasty)
 complex or revision knee replacement.
TOTAL KNEE REPLACEMENT
  Total knee replacement operations involve
replacing the joint surface at the end of
your thigh bone (femur) and the joint
surface at the top of your shin bone (tibia).
 A total knee replacement may also involve
replacing the under-surface of your kneecap
(patella) with a smooth plastic dome. Some
surgeons prefer to preserve the natural
patella if possible
UNICOMPARTIMENTAL PARTIAL KNEE
REPLACEMENT

 There are three compartments of the knee –


the inner (medial), the outer (lateral) and the
kneecap (patellofemoral). If arthritis affects
only one side of your knee – usually the inner
side – it may be possible to have a half-knee
replacement (sometimes called
unicompartmental or partial replacement).
 Because this involves less interference with the
knee than a total knee replacement, it usually
means a quicker recovery and better function.
KNEECAP REPLACEMENT
(PATELLOFEMORAL ARTHROPLASTY)

 A kneecap replacement involves replacing


just the under-surface of the kneecap and
its groove
 The operation has a higher rate of failure
than total knee replacement
 Some surgeons advise a total knee
replacement as the results are more
predictable. Others feel that it’s better to
preserve the rest of the knee joint if it isn’t
affected by arthritis.
IMPLANT COMPONENTS
 Implants are made of metal alloys,
ceramic material, or strong plastic parts.
Up to three bone surfaces may be
replaced in a total knee replacement:
 The lower ends of the femur.

 The top surface of the tibia.

 The back surface of the patella.


IMPLANT DESIGNS
 Posterior-Stabilized Designs

 Cruciate-Retaining Designs

 Unicompartmental Implants
POSTERIOR STABILIZED
DESIGN
 One of the most commonly used type of
implant in total knee replacement is a
posterior-stabilized component. In this
design, the cruciate ligaments are removed
and parts of the implant substitute for the
posterior cruciate ligament (PCL).
 The tibial component has a raised surface
with an internal post that fits into a special
bar (called a cam) in the femoral component.
CRUCIATE RETAINING
DESIGN
 As the name implies, the posterior
cruciate ligament is kept with this
implant design (the anterior cruciate
ligament is removed).
  This implant may be appropriate for a
patient whose posterior cruciate ligament
is healthy enough to continue stabilizing
the knee joint.
BICRUCIATE RETAINING
DESIGN
 In bicruciate-retaining designs, both the
anterior and posterior cruciate ligaments
are kept.
 The rationale for this type of design is that
by saving both ligaments, the knee will
function and feel more like a non-replaced
knee.
IMPLANT FIXATION
 There are different types of fixation used to connect knee implants to the bone.
 Cemented fixation. Implants are most commonly held in place with a fast-
curing bone cement (polymethylmethacrylate).
 Cementless fixation. Implants can also be "press-fit" onto bone. This type of
fixation relies on new bone growing into the surface of the implant. Cementless
implants are made of a material that attracts new bone growth. Most are textured
or coated so that the new bone actually grows into the surface of the implant.
 Hybrid fixation. In hybrid fixation for total knee replacement, the femoral
component is inserted without cement, and the tibial and patellar components are
inserted with cement.
INDICATIONS
 Osteoarthritis
 rheumatoid arthritis/inflammatory arthritis
 posttraumatic degenerative joint disease
 osteonecrosis/joint collapse with cartilage destruction.
 Trauma: Damage to the knee from a fall, automobile accident, or workplace or
athletic injury
RISK FACTORS LEADING TO
TKR
 Genetic: Both OA and RA tend to run in families.
 Age: Knee cartilage becomes thinner and weaker.
 Sex: Women athletes have three times as many knee injuries as men.
 Biomechanical: Certain types of leg or foot deformities, such as bowlegs or difference in leg
length, are at increased risk of knee disorders because the stresses on the knee joint are not
distributed normally.
 Gait-related factors: Irregular walking patterns .
 Shoes: High heels, Poorly fitted or worn-out shoes contribute to knee strain by increasing the
force transmitted upward to the knee when the foot strikes the sidewalk or other hard surface.
 Work or other activities that involve jumping, jogging, or squatting: Tends to loosen the
ligaments that hold the parts of the knee joint in alignment
CONTRAINDICATIONS
 active knee sepsis
 previously untreated or chronic osteomyelitis
 ongoing remote source of infection
 Extensor mechanism dysfunction
 Severe vascular disease
 Recurvatum deformity secondary to muscular weakness
 Presence of a well-functioning knee arthrodesis
 Skin conditions within the field of surgery (eg, psoriasis)
 Neuropathic joint
 Obesity
COMPLICATIONS AFTER
SURGERY
 Infection
 Blood clot/deep vein thrombosis
 Implant loosening
 Implant breakage- The most common components to break are the plastic
tibial, or shinbone, spacer and the patella, or kneecap, implant, which is also
plastic.
 Excessive joint stiffness
REHABILITATION EXERCISE
PROTOCOL
 Pre.op (1-2 weeks prior to surgery)

 Education on the surgical process and outcomes

 Instruction on a post. op exercise program

 Assessment of the home environment


POST. OP DAY 1
 Bedside exercises: ankle pumps, quadriceps
sets, gluteal sets

 Review of weight bearing status

 Bed mobility and transfer training: bed


to/from chair
POST. OP DAY 2
 Knee ROM
 - knee extension 0 degree
 - knee flexion as tolerated
 Continue knee strengthening/quads facilitation
 - Static quads / Inner range quads
 - Straight leg raises
 - Neuromuscular electrical stimulation asnecessary
 Swelling management
 - lce (20mins, 3 times a day)
 - Retrograde massage
POST. OP DAY 2 CONT.
 Encourage independent bed mobility
 Ambulate with walking frame/crutches
quadstick as deem safe forpatient.
 Commerce stair training if patient issteady
on level ground.
POST. OP DAY 3-5
 Progression of ROM and strengthening
exercises to the patient tolerance

 Progression of ambulation on level


surfaces and stairs (if applicable) with the
least restrictive device

 Progression of ADL training


DISCHARGE CRITERIA
 Discharge Criteria
 Knee Range of motion 0° - 90°
 Able to ambulate safely with aids
 Able to climb stairs (depending on homeenvironment)
 Average length of stays = 4-5 Days
DISCHARGE INSTRUCTIONS
 Early rehab is critical for faster recovery and long term results ofsurgery
 Resume activities of daily living gradually
 Avoid excessive stairs climbing
 Avoid jumping, kneeling or squatting
 Look out for signs of infections
 Continue with home exercise program and ice therapy daily
 Continue to practice walking with walking aids daily
 Return for outpatient rehab program
HOME EXERCISES
 Quadriceps sets
 Ankle pumps
 Straight leg raises
 Supported leg raise
 Prone knee flexion
 Standing knee curls
 Stepups
 Stationary cycling
PRECAUTIONS AFTER TKR
 Do not attempt to do these exercises unless your doctor or physical therapist
has given consent to do so

 Doing advanced exercises too early in your rehabilitation can damage the
prosthesis as well as set your recovery back

 Avoid exercises that are not prescribed by your doctor, especially those that
place excessive pressure on the knee joint, such as lunges or squats.

You might also like