• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications
• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications
• Increase in both primary and revision TKR*; primary
TKR vol. at 313 per 100,000 in 1990-1994, to 634 per
• Shifting towards Sub-specialty surgeons • Avg. duration for TKR declined 160min in 1997 to
• Morbidities and mortalities also declined in general
• Implementation of National Guidelines, clinical
*Kutz et al; J Arthroplasty. 2009;24:195-203
• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications
• AAOS guidelines* • Literature since 1996 shows no significant
differences in the rate of symptomatic PE with the use of LMW Heparin, warfarin, or mechanical devices and ASA alone
• Bleeding as a serious side effect • The American College of Chest Physicains study
concluded that ASA is as affective, but study flaws exist
• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications
• Computer Navigation vs. case-specific cutting jigs • Mechanical axis restoration as a predicator of
• Computer navigation associated with higher
number of knees iethin 3 degrees of a neutral mechanial alignment (88% vs. 61%)**
• Increase in surgical time but an average of
*Fang etal. J Arthroplasty. 2009;24:39-43 **Choong PF etal. J Arthoplasty. 2009;24:560-9
• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications
• Tendon preserving, muscle preserving, and smaller incision • Increased surgical time, potential of malalignment and
wound complications and limited early benefit*
• Effect of anterior tibial translation and patellar eversion. No
significant difference in early recovery in a randomized
• Serum levels (Creat. Phospokinase, myoglobin, aldolase,
lact. Dehy., creat.) ; no difference ***
• Higher revision rates in unicompartmental **** *Karpman et al. J Arthroplasty. 2009;24-681-8 **Da;ury DF et al. JBJS Am. 2009;91:1339-43 ***Niki et al. J Arthroplasty. 2009;24:499-504 ****Hamilton et al. J Arthroplasty. 2010;25:735-40
• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications
• Pain management: use of nerve blocks after
TKR, there is an early post op benefit (up to 24-72 hrs) of decrease in pain and opioid use, but no clinical benefit or improved outcomes beyond this period
• Tourniquet down before or after wound
*Shum et al. J Arthroplasty. 2009;24:204-9 **Steffin et al. J Arthroplasty. 2009;24:539-42
• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications
• No significant improvement of range of
motion in multiple prospective randomized studies up to 2 years*
• Await long term survival results to determine
• Rotation may facilitate optimal patellar
• Randomized prospective studies of up to 5
years showed no clinical benefit in any of the above
Gioe et al. JBJS Am. 2009;91:2104-12 Engh et al. J Arthroplasty. 2009;24:28-32
prospective study of pts. That underwent a cruciate retaining TKR for OA with and with out patellar replacement: no difference in the two groups in terms of ROM, Knee Society Score, anterior knee pain or overall revision; however rate of patellar revision was higher in the unresurfaced group (12% vs. 3%)
• 15 yrs f/up of modular posterior stabilized TK
• 10 yr f/up of all-polyethylene and metal backed
tibial components. Both implants had a survival rate of 97%**
• Uncemented trabecular metal tibial component
at 3 years follow up shows a consistent stable fixation compared to cemented implants***
*Lachiewicz et al. JBJS Am. 2009;91:1419-23 **Bettinson et al. JBJS Am. 2009;91:1587-94 ***Dunbar et al. JBJS Am. 2009;91:1578-86
• Hospital volume and surgeon volume affect outcome , but
studies indicate that hospitals with standardized processes
had equal outcomes to high volume hospitals*
• Staged vs. simultaneous TKR: no difference in a new study
from the New Zealand National Joint Registry**
• No support of use of antibiotic cement for primary TKR*** • Outcome and satisfaction may be improved if TKR done at
*Manley et al. J Arthroplasty. 2009;24:1061-7. **Hooper et al. J Arthroplasty. 2009;24:1174-7. ***Namba et al. J Arthroplasty. 2009;24(6 suppl):44-7. ****Gandhi et al. J Arthroplasty. 2009;24:716-21
• In the morbid obese, comparing BMI of <30,
30-39 and >39: no difference in outcomes but increase in patellar radiolucency in BMI >39 at a mean f/up of 5.4 years*
• Neuropathic arthropathy with mean f/up of
12 years: showed improvements in Knee score. Complications incl. knee dislocation**
*Dewan et al. J Arthroplasty. 2009;24:89-94 **Bae et al. J Arthroplasty. 2009;24:1152-6
• Epidemiology • Venous Thromboembolism • Navigation • Minimally Invasive Surgery • Perioperative Care • Outcome Studies • Complications
• Infection: rates of .5% for primary and 2% for
revision. Risk factors: male, Rheumatoid Arth., Fx
about the knee, and use of hinged or constrained
• Patients with un-controlled diabetes had higher
risk of stroke, UTI, ileus, post-hematoma,
transfusion, wound infection and death. Routine
Endocrinology consultation is recommended to
*Jameson et al. JBJS BR. 2010;92:123-9 **Marchant et al. JBJS Am. 2009;91:1621-9
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