Total knee arthroplasty
- Gregory M Martin, MD
Gregory M Martin, MD
- Medical Director, Orthopedic Institute at JFK Medical Center
- Preferred Orthopedics of the Palm Beaches
- Thomas S Thornhill, MD
Thomas S Thornhill, MD
- John B and Buckminster Brown Professor of Orthopaedic Surgery
- Harvard Medical School
- Jeffrey N Katz, MD, MSc
Jeffrey N Katz, MD, MSc
- Professor of Medicine and Orthopedic Surgery
- Harvard Medical School
- Section Editor
- Daniel E Furst, MD
Daniel E Furst, MD
- Section Editor — Treatment Issues in Rheumatology
- Clinical professor, University of Washington, Seattle
- Clinical professor, University of Florence, Florence, Italy
- Professor of Rheumatology, University of California in Los Angeles (Emeritus)
- Director of Research, Pacific Arthritis Associates
Total knee arthroplasty, also known as total knee replacement, is one of the most commonly performed orthopedic procedures. As of 2010, over 600,000 total knee replacements were being performed annually in the United States and were increasingly common . Among older patients in the United States, the per capita number of primary total knee replacements doubled from 1991 to 2010 (from 31 to 62 per 10,000 Medicare enrollees annually) . The number of total knee replacements performed annually in the United States is expected to grow by 673 percent to 3.48 million procedures by 2030 . A variety of pathologic conditions affecting the knee can be treated with total knee replacement, leading to pain relief, to restoration of function, and to mobility.
The normal knee joint functions as a complex hinge, primarily allowing flexion and extension but also allowing rotation and gliding. The knee joint is made up of three compartments: lateral, medial, and patellofemoral. Damage to the cartilage of one or more compartments may be the result of osteoarthritis (idiopathic or posttraumatic), inflammatory arthritis (rheumatoid, psoriatic, etc), avascular necrosis, tumors, or congenital deformities. Over 95 percent of total knee replacements in the United States are performed for osteoarthritis [1,4].
The introduction of the “total condylar prosthesis” by Insall and colleagues in 1972 is generally considered to mark the era of “modern” knee replacement . 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, as well as improved function and quality of life .
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 preoperative, operative, and postoperative considerations.
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- PREOPERATIVE EVALUATION
- - Symptoms
- Comorbid medical problems/review of systems
- - Medications
- - Allergies
- Physical examination
- - Observation
- - Palpation
- - Assessment with other manual tests
- Imaging studies
- Laboratory studies
- Review of treatment alternatives
- Discussion of risks and benefits
- - Risks
- - Benefits
- Blood conservation
- ALTERNATIVES TO TOTAL KNEE ARTHROPLASTY
- Nonsurgical treatment
- - Varus knee
- - Valgus knee
- Unicompartmental knee replacement
- Knee arthrodesis
- SURGICAL TECHNIQUE
- CHOICE OF PROSTHESIS AND FIXATION TECHNIQUE
- Retention versus sacrifice of the posterior cruciate ligament
- Fixation technique
- Patella resurfacing
- Other designs
- Emerging technologies
- POSTOPERATIVE MANAGEMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS