http://lifeinmotion.co.in/
We Provide These Services :
Total Knee Replacement,
Revision Joint Replacement Surgery,
Total Hip Replacement
In modern total knee replacement surgery, only the worn out cartilage surfaces of the joint are replaced.
The entire knee is not actually replaced. The operation is basically a resurfacing (or “retread”) procedure. On resurfaced area, hip or knee joints made up of specialized alloy metal and ultra high density polyethylene (UHDP)plastic are placed.
2. Objectives of today’s discussion
• Discuss the prevalence of degenerative Knee
Osteoarthritis (OA)
• Understand and discuss different approaches to treat
Knee OA
• Discuss the Indications, Priority and Clinical outcomes
of Knee Replacement
3.
• The knee joint is protected
in front by the patella
• Meniscus - acts as a shock
absorber
• Articular cartilage allows
the surfaces of the knee
to glide over each other
without damaging the
surface
Anatomy of Knee
4.
5. Prevalence of Knee Pain
(Croft et al, 1998)
7,500• Knee pain, some disability & X-ray OA
12,500• Knee pain with some disability
25,000• 4 weeks of knee pain in past year
• Knee pain, severe disability & X-ray OA
2,000
100,000• Subjects aged 55 years+
2%
6. • About 7 crore Indians are suffering from knee related
problems
• Evidence suggests that women have a higher incidence
of OA than men, and overall have an incidence of 2.95
per 1000 population, compared with 1.71 per 1000
population in men
Prevalence of Knee OA
7. Why is this problem more prevalent in
India
• Squatting / Ground sitting habits
• Climbing stairs
• Indian Toilets
• Obesity
• Complicated patients
• Heredity
Can we prevent Osteoarthritis
8. Symptoms
• Pain in and around the Knee joint
• Morning Stiffness (worse on standing &
attempting to walk)
• Swelling of Joint
• Occasional night pain
Characteristics of Knee OA
The symptoms of OA may interfere with normal
activities, such as walking, dressing and sleep
9. Characteristics of Knee OA
Signs
• Crepitus on motion
• Buckling or instability
• Tenderness on pressure
• Joint effusion
• Malalignment / Joint deformity
13. Education
• Education of Patients
– helps in reducing impact of condition on their
day-to-day lives
• Advice about lifestyle
• Impact vs. Non impact activities
15. Physical and Mechanical Interventions
• Heat and Cold applications
– to reduce inflammation
• Walking aids
– reduce the loading on the knee while walking
• Shoe alterations
– help the patient get their footwear right
– Knee braces
16. Physiotherapy
• Physiotherapy aims to restore function to
the maximum degree possible – through
exercises
– helps reduce pain
– increases joint range of movement
– improves muscles strength
– addresses specific restrictions in activities
• Exercises:
- Static Quadriceps Exercises
- Quadriceps Building Exercises
- Hamstring Building Exercises
- Isokinetic Exercises for knee joint
- Progressive resistance Exercises
17. PRECAUTIONSPRECAUTIONS
• Take rest in between if it is needed
• No squatting on floor
• No cross legged sitting (Alathi – Palathi)
on floor
• Reduce climbing stairs
• Cycling is good
• Swimming Mother of all exercises
24. ‘Ideal’ Patient
• Pain on weight-bearing motion.
• Simple analgesics do not always alleviate pain
• Active, mobile, lifestyle
• Cartilage degeneration not complete
• No acute, severe inflammation in the knee
• Prior correction of significant valgus/varus deformities,
ligamentous laxity or meniscal instability.
25. Patient Selection: (hylan G-F 20) Results
Across Radiologic Grades
P < 0.05; (χ2
)
Radiograp
hic grade
Grade I Grade II Grade III Grade IV
% patients
judged as
“better” or
“much better”
91 80 66 58
From a retrospective chart survey of 336 patients treated with
SYNVISC (1537 total injections)1
1. Lussier A et al. J Rheumatol. 1996;23:1579-1585.
Please see full Prescribing Information.
27. How do we know that the
patient needs surgery ?
• Regular pain needing medication
• Deformity of the knee, crepitus in knee
• Night pain, getting up pain
• Altered social or family life due to pain
29. • FIVE LAKH IS THE NUMBER OF KNEE
REPLACEMENT SURGRIES DONE IN USA IN
2008
• IN INDIA THE CORRESPONDING NUMBER IS
35000 IN 2008
• WITH ALL OUR MANFORCE WE ARE ABLE
TO TACKLE ONLY 3% OF TOTAL ARTHRITIS
PATIENTS
• WHERE ARE WE ???????
32. Total Knee Replacement
• The ultimate solution for OA of knee is to replace the
worn-out parts of the knee with an artificial joint
• The prosthesis that is used is made up of plastic and
metal and is placed on the joint surface of each bone
• This surgery has been widely used for many years with
excellent results especially for knees
43. Common Post-Operative (TKR) Course
• Day 1 Standing, bending and sitting out in a chair
May take a few steps with help
• Day 2 Walking (with aids)
• Day 4/5 Stair climbing
• Day 5-7 Home (with 2 walking sticks)
• Week 6 Walking unaided (or 1 stick)
Driving
• Week 10-12 Full recovery
44. Benefits of TKR
• TKR can relieve pain that doesn't respond to other
treatment options
• Pain reduction in 90 to 95% of the patients
• Reduced stiffness and improved joint movement
• Increased walking ability
• Improved alignment of deformed joints
45. Myths
• Hip replacement works but knee replacement doesn’t
• Knee replacements are still experimental
• Knee replacements only last 8-10 years may be 15 years
maximum
• I am too fat - my implants might break
46. • TKR surgery is too costly
• TKR is not successful
• After TKR, I have to be bedridden for 3 months
• A total knee replacement implies that everything about the
joint is being replaced
Myths
48. Summary
• Knee OA, which has not responded to conservative treatment
can be effectively treated by various surgical interventions
• Effective grading of patients, counceling and management
serves as a tool to combat osteoarthritis
• Knee replacement surgery is a highly successful
(90-95%) and safe procedure
• Prioritising and effective screening by GPs can identify those
individuals that are likely to benefit from TKR
51. Future ………
• Robotics
• Custom Implants and Instruments
• Stem cell therapy
Appreciate your attentionAppreciate your attention
Hinweis der Redaktion
Slide 35
Synovial fluid in the pathologic joint does not have the same elastic and viscous properties as SF of the healthy joint. Therefore, the lubricating and shock absorbing effects of hyaluronan in the joint space and intercellular matrix are diminished.1
Current OA treatment focuses on decreasing pain with analgesics and anti-inflammatory drugs. Viscosupplementation improves the physiological environment in the osteoarthritic joint by reestablishing shock absorption and lubrication to the cartilage and soft tissues that it bathes and permeates. Thus, it directly addresses the tissues that are the source of the OA pain.1,2
Viscosupplementation improves the elastoviscous environment of the collagen fibrous network, the cells, and the nociceptors.1
1Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis.
J Rheumatol. 1993;20(suppl 39):3-9.
2Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with Hylan G-F 20: a 26-week controlled
trial of efficacy and safety in the osteoarthritic knee. Clin Ther. 1998;20:410-423.
Slide &lt;number&gt;
The changes in physical properties due to this cross-linking can be easily seen. From left to right are: Supartz® (sodium hyaluronate), with a molecular weight of 0.6-1, SYNVISC® (hylan G-F 20), with a molecular weight of 6 million, and Hyalgan® (sodium hyaluronate), with a molecular weight of 0.6-0.7.