Knee Arthroplasty Lee W. Hash, M.D.

Affinity Orthopedics & Sports Medicine

1531 S. Madison Street, Appleton

Lee W. Hash, MD

• BA, 1984 - Luther College, Decorah, IA

• MD, 1988 - U of Iowa, Iowa City, IA

• Orthopedic Residency 1993- Albany,

NY

• USAF Orthopedic Surgeon 1993-1999

• Private Practice 1999-2006- Scottsbluff,

NE

• Affinity Medical Group 2006- present-

Appleton, WI

Knee Replacement Surgery

• 1996-2002 200% Increase in TKR

• 500,000 TKR in 2005

• 3.5 million/year by 2030 projected

What Causes Knee Joint Pain?

•One of the most common causes of joint

pain is arthritis. The most common types of

arthritis are:

– Osteoarthritis (OA)

– Rheumatoid Arthritis (RA)

– Post-traumatic Arthritis

– Osteonecrosis •Normal knee •Diseased knee

Osteoarthritis (OA)

• Also called arthritis, degenerative joint

disease, wear & tear arthritis

• >20 million Americans

• Characterized by joint pain associated with

injury, overuse and increasing age

• Two general features:

– Loss of articular cartilage

– Formation of bone spurs

Osteoarthritis (OA)

• Clinically marked by

– “Achy” joint pain

– End of day stiffness

– Swelling

– Difficulty arising from a seated position

• OA becomes nearly universal by age 70

• Most commonly effects the knees, hips

fingers, and spine

Risk Factors for Osteoarthritis (OA)

• Joint stress = Load x Activity

– Fractures

– Family History

– Overweight

– Natural problems of joint alignment

– Women > Men

Osteoarthritis (OA)

• Progresses slowly

– Ache after physical work or exercise

– Pain, sometimes steady

– Tenderness near the joint

– “Crunching” feeling when used (crepitus)

– Difficulty climbing in & out of chairs, cars, bath

tub

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Menomonie, WI

Treatment Options

Education

Activity Modification

Exercise

Weight Loss

Bracing (Neoprene, Ace)

Thermal therapies

Pool Therapy

Nutraceuticals

Tylenol

Creams (ie capsaicin)

NSAIDs

Cortisone injections

Hyaluronate injections

Surgical options:

-Arthroscopy

-Osteotomy

-Partial replacement

-Total knee

replacement

Surgery

• Arthroscopic surgery

– A knee “scope”

• Osteotomy

– A knee realignment procedure

– Better in younger patients

• Partial joint replacement

– Most effective early in disease

• Total joint replacement

– Complete replacement of the knee joint with metal & plastic

TKR

• Preop and postop expectations

• What is done

• What has changed

• Recovery time

Benefits of Knee Replacement

• Pain Relief

• Improved Walking

• Less Knee Stiffness

• Improved Leg Alignment

Results of Knee Replacement

0

20

40

60

80

100

Pain Relief Improved

Motion

Normal

Walk

Improved

Align

Pain Relief Improved Motion Normal Walk Improved Align

%

Knee Replacement

Surgical Procedure

• Patient is anesthetized

• Incision is made

• Arthritic surface at the end of the thigh

bone or femur is removed

• Bone is prepared for a new covering

• Femoral component is attached

Source: www.Jointreplacement.com, 2003

Surgical Procedure

• Tibial surface is resected

• Patella is prepared

• Components are “trialed”

• Final components are cemented in place

• Incision is closed

Total Knee Joint Replacement

– End surface of femur

replaced with metal

– End surface of tibia

replaced with metal

– Plastic liner is

inserted between

femur and tibia to

reduce wear

– Patella is resurfaced

with plastic

TKR

• Design of components

– Radius of curvature

• “round” Knee

• Gender specific

– PCL retention vs sacrifice

– Mobile vs fixed bearing

Rotating platform

TKR

• Polyethylene

– Delamination

– Sterilization

– Crosslinking

– Conformity

TKR – Surgical

• Computer assisted surgery

• Robotic assisted surgery

• Custom TKR cutting blocks

• Surgical approach

• Post-operative

Normal Knee X-ray Arthritic Knee X-ray

Replaced Knee X-ray

Anterior View Lateral View

Unicompartmental Replacement

TKR Recovery

• Hospital stay 2-3 days

• Therapy- ROM, strength, edema control

• Off work 2-3 months

• Gradual improvement 6-12 months

Knee Surgery

•May be suitable for patients who:

– Have a painful, disabling joint disease of the

knee resulting from a severe form of arthritis

– Are not likely to achieve satisfactory results from

less invasive procedures, medication, physical

therapy, or joint fluid supplements

Complications of Knee

Replacement

3 0.5 3 2

0

20

40

60

80

100

Blood

Clots

Infection Motion

Problems

Wound

Healing

Blood Clots Infection Motion Problems Wound Healing

Other Rare Complications

• Death

• Infection

• Sciatica

• Dislocation

• Phlebitis

• Nerve Injury

• Deep Vein Thrombosis

• Bone Fractures

• Hemorrhage

• Loosening of Implant

• Leg Length Inequality

• Knee Instability

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Summary

Osteoarthritis (OA) is characterized by

joint pain associated with injury,

overuse and increasing age.

Best when recognized early.

Summary

Early: activity modification, exercise

Bracing

Nutraceuticals?

Tylenol, NSAIDs

Summary

Cortisone & Hyaluronate injections

Arthroscopy

Osteotomy

Partial or Total joint replacement

Summary

Joint Camp at St. Elizabeth Hospital

• Pre-Op Teaching: PACE

• An organized Joint Camp group teaching once weekly in the

Helen Fowler Conference Room

• Centralized outpatient labs/EKG/radiology

• Medical clearance

• Designate a “coach,” to be present at Joint Camp

• Consider post-op plans

Affinity Joint Camp

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Thank You

Lee W. Hash, M.D.

Affinity Orthopaedics & Sports Medicine

1531 S. Madison Street, Appleton

(920) 996-3700

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