Total Knee Replacement

20 February, 2019 10:14:00 PM

Indrajit Sardar, an Orthopedic Surgeon

Total Knee Replacement (TKR) is a misnomer. It is a surface replacement operation.The original knee remains, only the joint surfaces which have worn out are replaced by a brand new highly polished metal coverings, between which a specially constructed polyethylene is placed. The metals are fixed to bone with Bone Cement. Uncemented knees are a novelty still, but are likely to gain in popularity in the near future.

The Femoral metal moves on the polyethylene, The polyethylene is either fixed by press fitting on the tibial metal (Fixed bearing knee) or rotates on the tibial metal (Mobile bearing knee).

Cruciate sacrificing

The mobile bearing knees usually are supposed to last longer, but long term results show no significant differences. The mobile bearing knees are also called Rotating Platform knees.

The femoral metal is usually of Coated Titanium or Stainless Steel or Cobalt Chrome alloy (Commonest).A newer Ceramicised metal alloyOxinium theoretically gives better survival but is yet to be proved clinically.

Oxinium

They are not MRI proof but nowadays, MRI technology has improved significantly, so that the high grade machines can do MRIs safely even in the presence of Total Knee Replacement implants. But it is imperative to inform the Radiologist that you have a Total Knee Replacement implant in you.

There are other varieties of Total Knee Replacement. In the fixed bearing knees—the surgeon can choose to retain the Posterior cruciate Ligament in the knee (Cruciate retaining Knee—or CR knee implant). Or the Posterior Cruciate Ligament (PCL), can be sacrificed (CS) knee or Cruciate Sacrificing Knee Implant can be used, In the CS knees, the function of the PCL is replaced by a Cam/Post system. The Femoral side has a deep notch cut to accommodate the Cam in the implant, which accommodates a post in the intervening polythene, which plays in the Cam. This is the earlier and still the most commonly used implant, and gives extra stability to the operated knee.

In the CR knee, less bone is sacrificed, the femoral metal does not have a cam but does have two pegs for better fixation of the metal to the bone. The intervening Polythene there fore has no post. The Modern Polyethylene has a Highly curved design on both medial and lateral sides which gives better antero posterior and medio--lateral stability.

In the long term there is no significant clinical differences between CR and CS Knee implants.

The other modifications are the Hi-Flex knees. The Posterior part of the Femoral Metal is engineered to produce a more curved shape which theoretically allows the knee to flex more. However increased knee flexion does not depend entirely on the design of the metal only. So Hi—Flex knees may not always give more bending of the knee.

The other controversy in Total Knee replacement is whether the Patella should be resurfaced or not.

Patella replacement

Since the pressures are less on the patella is a CR Knee, many surgeons are now opting not to replace the patellar surface with a Polyethylene implant. This has been helped by modern patellar polyethylene designs and better Patellar Groove designs on the Femoral metal. Moreover if the Patellar thickness is less than 20 mm, the bone cuts required to fit the polyethylene would render the residual patella thinner and more susceptible to fracture.

So the patella is shaped by an operation called Patelloplasty which is working well.

Total Knee Replacement is now a highly successful, predictable operation which is being done on a regular basis in many hospitals in Kolkata for the last two decades.

10:14:00 PM {"id":84,"user_id":1,"title":"Total Knee Replacement","slug":"total-knee-replacement","excerpt":"","content":"<img src=\"\/storage\/app\/media\/Indrajit%20Sardar.jpg\" width=\"100px\" \/> Indrajit Sardar, an Orthopedic Surgeon<\/strong> <\/p>\r\nTotal Knee Replacement (TKR) is a misnomer. It is a surface replacement operation.The original knee remains, only the joint surfaces which have worn out are replaced by a brand new highly polished metal coverings, between which a specially constructed polyethylene is placed. The metals are fixed to bone with Bone Cement. Uncemented knees are a novelty still, but are likely to gain in popularity in the near future. <\/p>\r\n<img src=\"\/storage\/app\/media\/totalkneereplacement-1.jpg\" \/><\/p>\r\nThe Femoral metal moves on the polyethylene, The polyethylene is either fixed by press fitting on the tibial metal (Fixed bearing knee) or rotates on the tibial metal (Mobile bearing knee). <\/p>\r\n<img src=\"\/storage\/app\/media\/totalkneereplacement-2.jpg\" \/><\/p>\r\nCruciate sacrificing<\/strong><\/p>\r\n <\/p>\r\n<img src=\"\/storage\/app\/media\/totalkneereplacement-3.jpg\" \/><\/p>\r\nThe mobile bearing knees usually are supposed to last longer, but long term results show no significant differences. The mobile bearing knees are also called Rotating Platform knees. <\/p>\r\n<img src=\"\/storage\/app\/media\/totalkneereplacement-4.jpg\" \/> <\/p>\r\nThe femoral metal is usually of Coated Titanium or Stainless Steel or Cobalt Chrome alloy  (Commonest).A newer Ceramicised metal alloyOxinium theoretically gives better survival but is yet to be proved clinically. <\/p>\r\n<img src=\"\/storage\/app\/media\/5.png\" \/><\/p>\r\nOxinium<\/p>\r\n They are not MRI proof but nowadays, MRI technology has improved significantly, so that the high grade machines can do MRIs safely even in the presence of Total Knee Replacement implants.  But it is imperative to inform the Radiologist that you have a Total Knee Replacement implant in you.<\/p>\r\nThere are other varieties of Total Knee Replacement. In the fixed bearing knees—the surgeon can choose to retain the Posterior cruciate Ligament in the knee (Cruciate retaining Knee—or CR knee implant). Or the Posterior Cruciate Ligament (PCL), can be sacrificed (CS) knee or Cruciate Sacrificing Knee Implant can be used, In the CS knees, the function of the PCL is replaced by a Cam\/Post system. The Femoral side has a deep notch cut to accommodate the Cam in the implant, which accommodates  a post in the intervening polythene, which plays in the Cam. This is the earlier and still the most commonly used implant, and gives extra stability to the operated knee.<\/p>\r\nIn the CR knee, less bone is sacrificed, the femoral metal does not have a cam but does have two pegs for better fixation of the metal to the bone. The intervening Polythene there fore has no post. The Modern Polyethylene has a Highly curved design on both medial and lateral sides which gives  better antero posterior and medio--lateral stability.<\/p>\r\nIn the long term there is no significant clinical differences between CR and CS Knee implants.<\/p>\r\nThe other modifications are the  Hi-Flex knees. The Posterior part of the  Femoral Metal is engineered to produce a more curved shape which theoretically allows  the knee to flex more. However increased knee flexion does not depend entirely on the design of the metal only. So Hi—Flex knees may not always give more bending of the knee. <\/p>\r\nThe other controversy in Total Knee replacement is whether the Patella should be resurfaced or not. <\/p>\r\n<img src=\"\/storage\/app\/media\/6.png\" \/><\/p>\r\nPatella replacement<\/p>\r\nSince the pressures are less on the patella is a  CR Knee, many surgeons are now opting not to replace the patellar surface with a Polyethylene implant. This has been helped by modern patellar polyethylene designs and better Patellar Groove designs on the Femoral metal. Moreover if the Patellar thickness is less than 20 mm, the bone cuts required to fit the polyethylene would render the residual patella thinner and more susceptible to fracture.<\/p>\r\nSo the patella is shaped by an operation called Patelloplasty which is working well.<\/p>\r\nTotal Knee Replacement is now a highly successful, predictable operation which is being done on a regular basis in many hospitals in Kolkata for the last two decades. <\/p>","content_html":"<img src=\"\/storage\/app\/media\/Indrajit%20Sardar.jpg\" width=\"100px\"> Indrajit Sardar, an Orthopedic\u00a0Surgeon<\/strong>\u00a0<\/p>\nTotal Knee Replacement (TKR) is a misnomer. It is a surface replacement operation.The original knee remains, only the joint surfaces which have worn out are replaced by a brand new highly polished metal coverings, between which a specially constructed polyethylene is placed. The metals are fixed to bone with Bone Cement. Uncemented knees are a novelty still, but are likely to gain in popularity in the near future.\u00a0<\/p>\n<img src=\"\/storage\/app\/media\/totalkneereplacement-1.jpg\"><\/p>\nThe Femoral metal moves on the polyethylene, The polyethylene is either fixed by press fitting on the tibial metal (Fixed bearing knee) or rotates on the tibial metal (Mobile bearing knee).\u00a0<\/p>\n<img src=\"\/storage\/app\/media\/totalkneereplacement-2.jpg\"><\/p>\nCruciate sacrificing<\/strong><\/p>\n\u00a0<\/p>\n<img src=\"\/storage\/app\/media\/totalkneereplacement-3.jpg\"><\/p>\nThe mobile bearing knees usually are supposed to last longer, but long term results show no significant differences. The mobile bearing knees are also called Rotating Platform knees.\u00a0<\/p>\n<img src=\"\/storage\/app\/media\/totalkneereplacement-4.jpg\">\u00a0<\/p>\nThe femoral metal is usually of Coated Titanium or Stainless Steel or Cobalt Chrome alloy\u00a0 (Commonest).A newer Ceramicised metal alloyOxinium theoretically gives better survival but is yet to be proved clinically.\u00a0<\/p>\n<img src=\"\/storage\/app\/media\/5.png\"><\/p>\nOxinium<\/p>\n\u00a0They are not MRI proof but nowadays, MRI technology has improved significantly, so that the high grade machines can do MRIs safely even in the presence of Total Knee Replacement implants.\u00a0 But it is imperative to inform the Radiologist that you have a Total Knee Replacement implant in you.<\/p>\nThere are other varieties of Total Knee Replacement. In the fixed bearing knees\u2014the surgeon can choose to retain the Posterior cruciate Ligament in the knee (Cruciate retaining Knee\u2014or CR knee implant). Or the Posterior Cruciate Ligament (PCL), can be sacrificed (CS) knee or Cruciate Sacrificing Knee Implant can be used,\u00a0In the CS knees, the function of the PCL is replaced by a Cam\/Post system. The Femoral side has a deep notch cut to accommodate the Cam in the implant, which accommodates\u00a0 a post in the intervening polythene, which plays in the Cam. This is the earlier and still the most commonly used implant, and gives extra stability to the operated knee.<\/p>\nIn the CR knee, less bone is sacrificed, the femoral metal does not have a cam but does have two pegs for better fixation of the metal to the bone. The intervening Polythene there fore has no post. The Modern Polyethylene has a Highly curved design on both medial and lateral sides which gives\u00a0 better antero posterior and medio--lateral stability.<\/p>\nIn the long term there is no significant clinical differences between CR and CS Knee implants.<\/p>\nThe other modifications are the\u00a0 Hi-Flex knees. The Posterior part of the\u00a0 Femoral Metal is engineered to produce a more curved shape which theoretically allows\u00a0 the knee to flex more. However increased knee flexion does not depend entirely on the design of the metal only. So Hi\u2014Flex knees may not always give more bending of the knee.\u00a0<\/p>\nThe other controversy in Total Knee replacement is whether the Patella should be resurfaced or not.\u00a0<\/p>\n<img src=\"\/storage\/app\/media\/6.png\"><\/p>\nPatella replacement<\/p>\nSince the pressures are less on the patella is a\u00a0 CR Knee, many surgeons are now opting not to replace the patellar surface with a Polyethylene implant. This has been helped by modern patellar polyethylene designs and better Patellar Groove designs on the Femoral metal. Moreover if the Patellar thickness is less than 20 mm, the bone cuts required to fit the polyethylene would render the residual patella thinner and more susceptible to fracture.<\/p>\nSo the patella is shaped by an operation called Patelloplasty which is working well.<\/p>\nTotal Knee Replacement is now a highly successful, predictable operation which is being done on a regular basis in many hospitals in Kolkata for the last two decades.\u00a0<\/p>","published_at":"2019-02-20 22:14:00","published":1,"created_at":"2019-02-20 22:13:20","updated_at":"2023-06-19 14:48:22","metadata":null,"ginopane_blogtaxonomy_series_id":null,"seo_title":null,"seo_description":null,"seo_keywords":null,"canonical_url":null,"redirect_url":null,"robot_index":null,"robot_follow":null,"summary":"<img src=\"\/storage\/app\/media\/Indrajit%20Sardar.jpg\" width=\"100px\"> Indrajit Sardar, an Orthopedic\u00a0Surgeon<\/strong>\u00a0<\/p>\nTotal Knee Replacement (TKR) is a misnomer. It is a surface replacement operation.The original knee remains, only the joint surfaces which have worn out are replaced by a brand new highly polished metal coverings, between which a specially constructed polyethylene is placed. The metals are fixed to bone with Bone Cement. Uncemented knees are a novelty still, but are likely to gain in popularity in the near future.\u00a0<\/p>\n<img src=\"\/storage\/app\/media\/totalkneereplacement-1.jpg\"><\/p>\nThe Femoral metal moves on the polyethylene, The polyethylene is either fixed by press fitting on the tibial metal (Fixed bearing knee) or r...<\/p><\/p><\/img><\/p>","has_summary":true,"categories":[{"id":20,"name":"\u099a\u09bf\u0995\u09bf\u09ce\u09b8\u09be\u09df \u09a8\u09a4\u09c1\u09a8 \u09a6\u09bf\u0997\u09a8\u09cd\u09a4","slug":"health-new-horizons","code":null,"description":"","parent_id":26,"nest_left":46,"nest_right":47,"nest_depth":1,"created_at":"2019-01-28 17:01:58","updated_at":"2019-03-26 16:47:50","url":"https:\/\/www.banglaworldwide.com\/category\/health-new-horizons","pivot":{"post_id":84,"category_id":20}},{"id":21,"name":"\u09a1\u09be\u0995\u09cd\u09a4\u09be\u09b0\u09ac\u09be\u09ac\u09c1 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