Cartilage : elastic tissue to cushion Ligaments : connects bone to bone Tendons : connects muscle to bone

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1 Dr. (Prof.) Anil Arora MS (Ortho) DNB (Ortho) Dip SIROT (USA) FAPOA (Korea), FIGOF (Germany), FJOA (Japan) Commonwealth Fellow Joint Replacement (Royal National Orthopaedic Hospital, London, UK) Senior Knee and Hip Replacement Surgeon Associate Director Department of Orthopaedics and Joint Replacement Max Superspeciality Hospital, Patparganj, Delhi (India) anilarora@delhiorthojournal.com

2 What is Knee Joint

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4 The Knee Joint

5 Cartilage : elastic tissue to cushion Ligaments : connects bone to bone Tendons : connects muscle to bone

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8 Common Causes of Knee Pain Most Common : ARTHRITIS»OSTEOARTHRITIS»RHEUMATOID ARTHRITIS»INFECTIVE ARTHRITIS»GOUT (Uric Acid) After Fractures and Ligament Injuries

9 Many Synonyms Osteoarthritis

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14 Outer Side

15 Symptoms 1. Pain at the start of activity that gets better warms up over time 2. Progressive pain with activities 3. Loss of motion 4. Crunching sensation in the knee 5. Swelling 6. Over time deformity can occur in the knee

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26 Walk Waddle

27 OA Management Slow progression over many years - Cannot be cured Treatment directed at symptoms and slowing progress of the condition Goals: Decreasing pain Increase range of motion Increase muscle strength

28 Treatment 1. Education 2. Activity modifications such as using a cane 3. Physiotherapy 4. Drugs 5. Braces 6. Injections?????? 7. Surgery

29 Injections Arthroscopy Osteotomies

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35 What is Total Knee Replacement Replacing damaged surface of the bone is called Total knee Replacement.

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37 Is total knee replacement for you? Yes if you have Severe knee pain that limits your everyday activities. Moderate or severe knee pain while resting, either day or night. Failure to obtain pain relief from pain killers. Prolonged use of pain killers. Inability to tolerate or complications from pain medications. Failure to substantially improve with other treatments.

38 Indication of Total Knee Replacement Pain interfering with normal routine Instability If you require painkillers everyday

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40 Total Knee ReplacementSurgery

41 Steps of Total Knee Replacement

42 Steps of Total Knee Replacement

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45 Knee Replacement

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47 Commonly asked Questions about Total Knee Replacement

48 When I will be able to walk? Next day! The patient can go to toilet independently very next day First with walker for a few days then using a walking stick.

49 Walk Next day!!!!!!

50 How much I will be able to walk? Depends on Stamina & is age related.

51 Will I be Able to climb the steps? Yes

52 Will I be able to sit cross-legged? Newer joints are available. But???????? Should we?

53 Does it take months to recover from the surgery? No. The patient then follows an intensive physiotherapy protocol and usually walks without support within 3-6 weeks.

54 Manju Tandon

55 Will I walk normal after TKR Mrs Bhatnagar walk

56 Pathway to Recovery : Physi cal Therapy The Physiotherapy Team will work with you to improve your functional abilities

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58 Will my knee become straight after operation Yes

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61 What does knee replacement offer? More than 95% of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living

62 Is it a rare surgery? No, it is not. Almost 3 lakh replacements are performed in the US every year. And India is catching up.

63 I have heard that Knee replacement is not successful and results are not good!!!

64 Diagnosis-Disease No other disease which may affect result Muscles and Nerves shall be OK and functional.

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66 Preop Anita Roy walk

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78 What if both knees have arthritis? Both knees can be replaced in the same sitting Else, sequential replacement can be done

79 What is the life of the joint? years is the normal expectancy. That is why it is not done in younger age group It should last the life of the patient but it can be repeated.

80 Is total knee replacement only for elderly or youngs?

81 I am a diabetic. Can my knees be replaced? Under strict blood sugar control, knee replacements can and is routinely performed on diabetics. However it requires blood glucose monitoring and control in preoperative and postoperative period.

82 I may never be able to sit cross legged after surgery! No, you can. Newer designs of implants permit higher range of motion and allow patient to sit cross legged. We don t want it!!!!!!!!!!!!!!!

83 Many varieties of implants are available. Which should be chosen? There is no documented evidence of superiority of one design over the other. So let your surgeon decide the implant

84 I took tons of Calcium. Why my knees are bad?

85 Any precautions after surgery? Regular light exercise Take special precautions to avoid falls and injuries. Notify your dentist that you had a knee replacement. See your orthopaedic surgeon periodically

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95 72 YR

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97 Anesthesia Spinal orgeneral anesthesia isrequired to be administered before yoursurgery Youwill meetyouranesthesiologistprior to surgery in the pre-op holding area YourAnesthesiologistwill review your history and discussthe bestoption foryou

98 Controlling Risk Factors Ifyouare overweight, losing weightwill help reduce the pressure on yourjointsand reduce yourpain Ifyouare diabetic, follow yourdiet,check yourblood sugarsatleasttwice daily, and take yourmedicationsasprescribed Ifyouare a smoker, stop 3 to 5daysbefore yoursurgery to decrease chancesoflung problemsand speed yourrecovery

99 Follow Up and Expectations My preference is to see patients at 6 weeks, 3 months, and 6 months after surgery You should also be given yearly follow up for x-rays Most people are doing well by 3 months and by 6 months can resume most activities

100 Motivation and participation in your therapy program are important to the speed and success of your joint replacement surgery

101 Recovery AtHome : Discharge Destination Once home, yourphysical therapy will continue Based on yourphysician s, nurse sand therapist s recommendationsyoumay choose: OutpatientPhysical Therapy: daily therapy atan outpatientfacility (transportation arrangementscan be made) Home Health: physical therapistwill come to yourhome 3 d daysperweek When a patientisnotmobile enough to go directly home, arrangementscan be made to go do a skilled inpatient facility

102 Steroids Injections Takes up to 7 days to take effect Possibility of infection (extremely rare) May last more than 6 months Visco supplements Role not established Hyalgan and Synvisc Multiple injections Usually used for early arthritis

103 Osteotomies Used to correct deformity due to arthritis Useful in younger patients Indications are more limited than knee replacement Some patients are candidates for osteotomies

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151 Selective Resurfacing

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