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Knee Arthritis and Total Knee Replacement DR. GREG TAYROSE UNIVERSITY ORTHOPEDICS AND SPORTS MEDICINE

Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

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Page 1: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Knee Arthritis and Total Knee Replacement DR. GREG TAYROSE UNIVERSITY ORTHOPEDICS AND SPORTS MEDICINE

Page 2: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Arthritis

What is arthritis? What are the symptoms of arthritis? What is the physical exam a physician will perform? What can be done to help? What are the indications for total knee replacement? What can I expect after surgery?

Page 3: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

What is Arthritis?

Arthritis is an inflammation of one of the joints in your body Symptoms include pain, swelling,

and stiffness

Everyday activities such as climbing stairs may be difficult with arthritis

How common is it? Roughly 50 million people in US

were told that they have some form of arthritis

Roughly 5 million people living in US with total knee replacements

Page 4: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Wear and Tear

Osteoarthritis

Also known as degenerative joint disease (DJD)

Most common type of arthritis of the knee It is “wear and tear” arthritis

It results in wearing away of cartilage and can result on bone on bone wear as well as bone spurs

Page 5: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Many Types of Arthritis

Arthritis Primary Arthritis- articular

degeneration without any apparent underlying reason

Secondary Arthritis- a consequence of with abnormal forces across the joint or abnormal articular cartilage

Page 6: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Symptoms

Pain or swelling may be worse in the morning or after sitting and resting

Vigorous activity may cause the pain to swell up

Loose fragments or cartilage may cause “locking” or “sticking” This is called crepitus

Page 7: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Symptoms

Pain may cause a feeling of weakness or buckling

Many people feel increase in joint pain with rainy weather

Page 8: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Knee Arthritis Assessment

Pain with weight bearing

Aggravated by stairs, hills, sit to stand

Bowing deformity and Instability Seen later in presentation

Page 9: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Exam

Occasionally pain can be referred from the hip or lower back to the knee

Selective anesthetic injections is occasionally needed to elucidate the relative contributions of overlapping pathologies

Page 10: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Exam

Joint swelling, redness, or warmth

Tenderness about the knee

Range of passive and active motion

Instability of joint

Any sign of injury to muscles, tendons, ligaments surrounding the knee

Page 11: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Imaging Studies

Radiographs are the standard for initial evaluation

Should include weight bearing studies

Page 12: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

MRI?

MRI Is grossly overused in the arthritic

patient population

If joint space is narrowed on radiograph then MRI is NOT indicated

Page 13: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Treatment

There is no cure for arthritis

But…. There are a number of treatments

that may help relieve pain and disability

Page 14: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Knee Arthritis Treatment

Non-operative

Activity Modification

Reduce impact- loading exercises

Reduce weight

Avoid stairs, incline, squatting

Page 15: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Injections

Joint Injections

Corticosteroid- anti-inflammatory

treatment

Hyaluronate

Page 16: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Canes and Braces

Unloading brace Can be helpful but low

compliance

Suited for exercises activity

Assist device Cane

Placed in opposite hand of affected knee

Page 17: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Arthroscopy

Not indicated for Arthritis

Success related to degree of

mechanical symptoms noted preoperatively Meniscal tears with catching and

locking

Loose bodies

Unstable cartilaginous flaps

Page 18: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Total Knee Arthroplasty

Indications Debilitating pain affecting

activities of daily living

Pain not well controlled by conservative measures

Medically fit for surgery

No active infection

Page 19: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Total Knee Arthroplasty

Total knee arthroplasty (TKA) survival Well-balanced knee

Neutral mechanical alignment

Page 20: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Post-operative Rehabilitation

Post-op

Quad sets, straight leg raises, ankle

pumps

Walking with crutches or walker

CPM machine

Page 21: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Survivorship

Decreased survivorship Younger age- 55 years or younger

Osteoarthritis

Due to high activity level

Increased survivorship Older age- 70 years or older

Rheumatoid arthritis

Cemented fixation of all components

Due to low activity level

Page 22: Knee Arthritis and Total Knee Replacement - Johnston …johnstonhealth.org/.../Knee-Arthritis-and-Total-Knee-Replacement.pdf · Symptoms include pain, ... Total Knee Arthroplasty

Questions?

Dr. Greg Tayrose

University Orthopaedics and Sports Medicine 166 Springbrook Avenue,

Suite 101 Clayton, NC 27520

Phone: (919) 550-3430 Fax: (919) 550-7403