A Comparison of TKA and PKA

Components for Partial and Total knee surgeries

(bonesmart.org)

Objectives

Define TKA and PKA Advantages/Disadvantages Indications for each procedure Rehabilitation Therapeutic exercises/activitiesHandout-How we can prepare our patients for

more successful recovery/what to expect

Brief review of knee surgeries… Currently in the U.S. 15 million people suffer from knee

osteoarthritis, from these 600,000 patients will undergo total knee procedures

Average age lies between 60-80 years old Approximately two-thirds of the patients are female Advances in knee replacements within the past 30 yrs offer

patients with severe knee injury ability to lead reasonable, full and active lives with minimal pain in the knee joint

There are dozens of different types of knee replacement prosthesis available

Joint prosthesis cost approximately $4,000-$ 6,000 Replacement surgery is successful in 9 out of 10 people

Usually infection or loose hardware results in a revision

Total knee arthroscopy (TKA) or replacement/resurfacing The traditional procedure for knee pain Major surgery, where diseased parts of the knee are removed and

replaced with artificial parts (prosthesis) 8-12 inch cut is made in front of the knee Quadriceps tendon (which is attached to patella) is cut and the patella is

turned over and pushed out of the way, or removed and replaced Replacement parts includes a rounded, U-shaped part that fits over the

end of the femur or the upper part of the joint, made out of metal. A flatter piece, metal too, is placed on the lower aspect of the knee and has a stem that fits down into the bone

Polyethylene plastic is inserted between the two metal portions, keeps the two metal parts from touching

Great outcomes- decreased pain in knee when damaged joint is relieved when new gliding surface is constructed

Longer hospital stay of 3 – 5 days Considerable pain post-op

Limitations to TKA

Difficulties with securing hardware long-term with bone loss of patient

Implant failure/breakage Infections Osteolysis Early loosening more in cementless TKA Malalignments Fracture Patella maltracking Deep vein thrombosis

Post-op care for TKA

Movement!!! Extension (optimal is less than or equal to -10) Flexion motions (optimal 80 -100 degrees +) WBAT No ROM limit Watch for acute complications

Increased pain, excessive swelling, decrease in muscle function or sensitivity, sudden SOB, persistent drainage or skin infection

Partial Knee Arthroscopy (PKA) or Unicompartmental (Uni)

One compartment of knee is affected Inlays and onlays are used to conserve diseased part of the joint

surface Surgeon reshapes damaged surface before installing hardware

(metal and plastic) Patella replacements are considered PKA Smaller incisions, 3-5 inch Less tissue damage (surgeon works between fibers of

quadriceps tendon instead of cutting through the tendon) Decreased pain Less blood loss Better motion due to less scar tissue formation Shorter length of hospital stay Shorter recovery rate

Limitations of PKA Surgery works if bone has not been damaged by arthritis Requires other side of knee to have healthy cartilage Usually require younger aged patient (under age 60)

Procedure not recommended for the following patients: Obese Sedentary Insulin dependant diabetes Osteoporosis RA

Bony visualization is limited, which could lead to malalignment of hardware

Post-op care for PKA

(Follow surgeon protocol) but there are no limitations as far as bending and straightening the knee

No weight bearing limits, (as tolerated) Do not overdue movement, can damage knee Treat edema with ice and elevation and moderate

rest as needed Physical therapy is recommended, but not as crucial

as recovery with TKA

Suggested Rehabilitation

EARLY ACTIVITY (see Nelson, Krista, Rolayne or Heather )

Depending on surgeon protocol, early activity- Counteracts effects of anesthesia Encourages healing Prevents atrophy of muscles Encourages healthy digestion Patient feels more normal, less restricted Some optimal early exercises- ankle pumps, quad sets,

heel slides, SAQ, LAQ and/or CPM use, deep breathing May counteract depression (change in mobility/lifestyle)

Rehabilitation cont.. Important to recover strength in operated leg and continue to maintain

strength in non-operated leg ,other extremities and core due to abnormal gait with limping

Address functional movements : Closed chain exercises-squats (on/off toilet, in and out of car, sitting on a

chair) Stairs (up with the good, down with the bad) Rolling (bed mobility) Ambulation on uneven surfaces

May take up to 6-12 months to restore strength from TKA, shorted for PKA

Speed of recovery/rehab depends on patient condition before surgery

Suggested low-impact activities: Walking, swimming, golfing, hiking, stationary bike ridingpilates

We are headed in the right direction…

TKA has undergone many advances over the past 20 yrs

Revision rates are low Improvements in surgical techniques and materials

have led to reliable pain relief for patients Implant survival rate greater than 90-95% at 10 yrs,

and approx 80% at 20 yr follow-up Need to continue to understand prosthetic failure

and methods for reconstruction in failed knees

Bibliography

Abraham, TR, Jr., Wright, JT.WebMD. Total Joint Replacement Rehabilitation. April 2012.URL:emedicine.medscape.com/article 320061. November 2012

Kaushik, AP, Scanelli, JA, Quanjun, C MDUS Musculoskeletal Review. Advances and Controversies in Total Knee Arthoplasty.Febuary 2011.URL:www.touchmusculoskeletal.com. October 2012

Skawara, A., Tibesku, CO, Rudolf, Reichelt.BMC Musculoskeletal Disorders. Damages of the tibial post constrained total knee prostheses in early postoperative course.June 2008.URL:www.biomedcentral.com. October 2012

www.bonesmart.org. The Foundation for the Advancement in Research in Medicine, Inc. Non Profit.2012

Thank-you!

-Heather Boies