Total Knee Replacement Techniques

Excerpt

Total knee arthroplasty (TKA) is a viable treatment for symptomatic osteoarthritis of the knee refractory to conservative measures. In those with end-stage degenerative changes compromising the articular cartilage affecting multiple compartments of the knee, the literature has yet to identify a potentially viable alternative option for the regeneration of cartilage. Thus, TKA has demonstrated reproducible, long-term, successful results in such patients concerning outcomes of decreased pain and improved overall quality of life.

Recent estimates project that by the year 2030, there will be 3.48 million TKAs performed annually. Although it is an extremely common and increasingly routine surgery, attention to detail is critical during the procedure to ensure that a well-balanced and functional TKA is performed to mitigate the risks of implanting components that might otherwise be subject to increased wear and early failure. Even with appropriate techniques, new technologic advances, and a better understanding of knee kinematics, approximately 1 out of 5 people that undergo a TKA will remain unsatisfied. There are numerous TKA designs and different levels of constraint that may be necessary for particular cases. Unicompartmental arthroplasty, cruciate retaining, and posterior stabilizing implants are typically used as potential index procedure options. However, in patients with significant varus/valgus instability, those undergoing revision surgery including component revisions, patients with preexisting poor bone quality, or in the setting of appreciable osseous defects, more constrained prosthetic components are given consideration. These include but are not limited to semi-constrained, hinged, or distal femoral replacement options.