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Total knee arthroplasty

INTRODUCTION

Total knee arthroplasty, also known as total knee replacement, is one of the most commonly performed orthopedic procedures. As of 1997, about 300,000 total knee replacements were being performed annually in the United States [1]. A variety of pathologic conditions affecting the knee can be treated in this way, leading to pain relief, restoration of function and mobility.

The normal knee joint functions as a complex hinge allowing primarily flexion and extension, but also rotation and gliding. The knee joint is made up of three compartments, the lateral, medial and patellofemoral. Damage to the cartilage of one or more compartments may be the result of osteoarthritis (idiopathic or post-traumatic), inflammatory arthritis (rheumatoid, psoriatic, etc.), avascular necrosis, tumors, or congenital deformities. Osteoarthritis and rheumatoid arthritis are the causes of the overwhelming majority of total joint arthroplasties [2].

The introduction of the "total condylar prosthesis" by Insall and colleagues in 1972 is generally agreed to mark the era of "modern" knee replacement [3]. This prosthesis was the first to replace all three compartments of the knee. There are variations of the original design and there is increasing interest in partial (unicompartmental) knee replacements. (See 'Choice of prosthesis and fixation technique' below and 'Alternatives to total knee arthroplasty' below.)

Modern total knee arthroplasty consists of resection of the diseased articular surfaces of the knee, followed by resurfacing with metal and polyethylene prosthetic components. For the properly selected patient, the procedure results in significant pain relief, improved function and quality of life [4].

Despite the potential benefits of total knee arthroplasty, it is an elective procedure and should only be considered after extensive discussion of the risks, benefits and alternatives. This topic reviews aspects of total knee arthroplasty including pre-operative, operative and post-operative considerations.

                                    

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Literature review current through: Apr 2012. | This topic last updated: Sep 29, 2010.
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