Total Knee Replacement in Arthritis - Current Concepts
- Pp. 105-127 (23)Narayan Hulse
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.