COMPONENTS OF TOTAL KNEE REPLACEMENT

TOTAL KNEE REPLACEMENT

PARTS OF KNEE REPLACEMENT PROSTHESIS

Introduction:

Total knee replacement is surgical procedure in which the damaged cartilage lining of bone is replaced with artificial components, thereby eliminating the pain caused by diseased joint.

The most common indication is completely worn out knee joint by osteoarthritis. Knee replacement is also considered in certain arthritic conditions like Rheumatoid arthritis.

Parts of Artificial knee implant:

The components of artificial knee replicate the shape of joint surface so as to allow smooth rolling and gliding movement. Structure and shape of knee joint varies from person to person and also across the genders. In order to address this, the implant companies manufacture artificial joints in different sizes so that the operating surgeon can choose the best fit.

There are also several designs of implant based on patient’s age, gender and lifestyle.  It is the surgeon who can choose and suggest the best design and brand that best suits your need.

There are three main parts

-         Femoral (thigh bone) component

-         Tibial (Shin bone) component

-         Plastic (Cushion) component

-         Patellar component

Femoral (Thigh bone) component:

The lower end of femur in knee joint is a curved surface with central groove allowing movement of knee cap. The prosthesis component is made up metal and is curved with central groove mimicking the natural surface of femur. Femoral component is made up Chrome cobalt alloy or Zirconium alloy or Oxinium .

Tibial (Shin bone) component:

The upper end of shin bone is replaced with flat metal platform which can accommodate Plastic (cushion). Tibial component is made of Titanium alloy or Chrome-cobalt alloy.

Plastic (Cushion):

The plastic (Cushion) is also called as insert accommodates into the tibial metal platform. The plastic component has inbuilt curvature to accept the curvature of femoral component. If surgeon prefers to do a ligament sparing surgery the plastic has notch to accommodate the cruciate ligaments. In case cruciate ligaments are removed it has cam to take over the function. The material used in the manufacturing of plastic is High Molecular Weight Polyethylene (HMWP).

Patellar component:

The back side of knee cap is also replaced by removing damaged cartilage with polyethylene button. Some absolute indications warrant’s patella replacement whereas in some cases its surgeons preference.

TYPES OF TOTAL KNEE PROSTHESIS DESIGN

TYPES OF KNEE PROSTHESIS

1.     Fixed bearing :

This is the most common implant design used. As the name implies the Plastic (polyethylene) insert is fixed firmly on the metal platform of tibia. The femoral component of the prosthesis rolls over this plastic (polyethylene) insert. This design provides motion of knee joint in one plane i.e. bending and straightening of knee.

2.     Mobile bearing implants (rotating platform)

In mobile bearing knee the plastic insert (polyethylene) can rotate short distances on the metal platform of tibia. This design allows few degrees of sideways rotation of knee. The mobile bearing implants needs good ligament support as it allows sideways rotation of knee. They are not indicated in cases where the ligaments are lax or loose. These knee designs are slightly costlier than fixed bearing designs.

3.     Medial pivot implants: 

A normal knee has a component of pivoting motion during bending of knee. This design replicates bending, twisting and rotating of your natural knee.

4.     Personalized implants:

The shape and size of bones in knee joint varies from person to person. During routine total knee replacement surgery, knee implants are available in 6 to 10 different sizes. The surgeon then selects the implant that closely matches with patient size and shape of bones and some minor adjustments are done to fix the implant to the bone. This technique sometimes compromises the precession fit of the implant to the bone. In few cases and instances, such minor adjustments are acceptable, but in few gross adjustments are disaster can result in early failure of knee implant.

To overcome such problem the knee implant companies came up with idea and devised

-         Customized implants ( implant design for a given patient)

-          Personalized implants (Gender specific)

Customized implants:

In order to create customized implant for a particular patient, surgeon gets MRI or CT scan and gets 3D images of the knee joint. This data is collected by the implant design companies to create patient specific instrumentation to make cuts in the bone. They also create patient specific knee implant which actually matches the natural knee.

Personalized implants: Gender specific:

Research studies have shown that there is mismatch in shape and size of bones of knee joint in males and females.  Due to such differences surgeons make some adjustments in the routine knee replacement surgery in order to fix the available implants especially in women.

The main difference in male and female knees is the shape of the lower end of thigh bone. In females lower end of thigh bone is smaller from side to side than front to back. To accommodate this change some implant companies have devised extra set of knee designs to fit female knees.

The choice of selecting customized or personalized implant design is a surgeon preference and changes from patient to patient.   

Posterior cruciate ligament (PCL) Retaining or Substituting implants:

Posterior cruciate ligament is one of the major ligaments in the knee. It prevents roll back of femur over the tibia when bending the knee. During knee replacement surgery this ligament can be preserved or removed based on surgeons choice, type of implant used and during surgical balancing of knee.

Posterior cruciate ligament (PCL) retaining:

In this surgical technique ligament is preserved which also gives additional stability. Femoral and tibial components have notches to accommodate the ligament and plastic insert is flat.

Posterior cruciate ligament (PCL) substituting:

In this surgical technique ligament is removed. In order to compensate the function of ligament the plastic insert has raised slope in front and post in the back. The femoral component has notch to accommodate the post which gives additional stability to that of lost ligament.

The choice of using the specific design and brand of implant is upon the surgeon. There are various factors in choosing the implant which could related to patient or surgeon himself.  Surgeon can choose a particular brand and design with which he is familiar and is best suited for the patient.  

Dr.A.Mohan Krishna
Consultant Orthopedic surgeon
Apollo hospital
Hyderabad,
Appointments :9247258989
                       9441184590
bonesandjointsclinic@gmail.com
www.drmohankrishna.com
www.bonesandjointsclinic.com

Total Joint replacement and Deep vein thrombosis (DVT)

What is a hip or knee replacement surgery?

Hip or knee replacement surgery involves replacing damaged joint lining of  hip or knee joint with metallic or plastic  implant, to repair the damaged surfaces that are causing pain.

Why would you need a hip or knee joint replacement surgery?

-         

     When your hip or knee joint has been damaged by arthritis, a fracture or other conditions due to which common activities such as walking or getting in and out of a chair become painful and difficult may require a joint replacement surgery.

-         In such cases the damaged joint may be so stiff and immovable that even simple activities like putting on your shoes and socks or climbing a few stairs is impossible.

-         You may feel uncomfortable while resting and the pain even continues during rest.

-         There is inadequate pain relief in spite of taking proper anti-inflammatory drugs, physical therapy, or walking supports.

     

      How does your surgeon (Doctor) decide whether you are fit for surgery?

-         

      Your orthopedic surgeon will enquire about your general health and ask questions about the extent of your joint pain and how it affects your ability to perform everyday activities.

-         The surgeon will assess the mobility, strength and alignment of the affected joint.

-         The surgeon will require X-rays to help him determine the extent of damage or deformity in your joint.

-         You may need opinion from cardiologist, general physician and anesthetist before proceeding to surgery.

     

      What happens during surgery?

      

      Your orthopedic surgeon will remove the damaged cartilage and bone and then position the new metallic implants to restore the alignment and function of your joint.

     

      What care should be taken post – surgery?

-         

       There will be some pain after the surgery but your surgeon will provide you necessary medication which should be taken in timely manner.

-         Though there is pain, the movement at the replaced joint should start soon after the surgery.

-         There will also be some antibiotics that you may need to take to  prevent infection.

-         Light exercises like walking are essential parts of recovery. If you do not move as early as possible some postoperative complications become likely.

     

      What is the significance of recommended medication?

-         

      You should continue to take the prescribed medications.

-         You will be recommended to take antibiotics before, during and after the surgical procedure to prevent any infection at the operated site.

-         After the surgery, many of the patients develop blood clots, hence blood thinners such as anticoagulants are recommended.

-         You should follow your doctor’s recommendations for the prescribed duration when blood thinning medications are given.

     

      What are the alert signs after surgery?

-         

       Do report to your doctor in case you observe any of the below

1.     Warmth and redness at the incision site.

2.     Unusual pain or tenderness at the incision site.

3.     Pain or warmth in the calf muscles.

4.     Development of an odor or strong smell.

What are the possible complications of the surgery?

Some possible complications of the surgery include:

1.     Infection that may or may not be limited to the skin of the wound.

2.     Leg-length inequality after hip replacement surgery.

3.     Blood clot formation or deep vein thrombosis (DVT)

What is Deep Vein Thrombosis (DVT)?

-         

     Blood clot formation is the most common complication of replacement surgery which may develop during first several weeks of your recovery.

-         The blood clots generally develop in the leg veins or pelvis.

-         These clots can be life threatening if they break free and travel to your lungs.

-         You should immediately visit your doctor of you develop any of the following warning signs:

1.     Increasing pain in your calf.

2.     Tenderness or redness above or below your knee.

3.     Increasing swelling in your calf, ankle and foot.

How can you prevent DVT?

-        

     Post-surgery, your doctor will outline a prevention program which will be helpful to reduce possibilities of a DVT event.

-         This may include blood thinning medications, inflatable leg coverings, ankle pump exercises and early mobilization.

OXINIUM KNEE

OXINIUM KNEE

Total knee replacement is a surgical procedure in which damaged cartilage of knee joint is replaced with metal lining and plastic cushion. This procedure provides pain free and functional knee joint to the patient.

Traditionally knee prosthesis is being manufactured from the cobalt-chrome alloys because of their strength and relative hardness. When the prosthesis is implanted, it undergoes cyclical loading and stress during usage of knee for daily activities. Over a period of time surface of cobalt – chrome implants gets roughened. When this roughened surface rubs over the plastic bearing surface the plastic wears out. The plastic wear debris secondarily reduces the prosthetic joint life and may warrant for revision surgery.

What is Oxinium:

Oxinium is patented metal alloy produced by SMITH & NEPHEW for the manufacture of knee and hip implants.

Oxinium is an oxidized Zirconium. The zirconium metal alloy is oxidized through a patented process, which then turns metal surface into ceramic. Oxinium implants have ceramic like surface and metal like structure.

This metal alloy has a combination of hardness, smoothness and scratch resistance. The ceramic surface of Oxinium metal alloy is two times harder and twice scratch resistance than cobalt-chrome alloys.  These additional properties produce less wear than cobalt-chrome alloy prosthesis.

Some facts about Oxinium:

·         Surface hardness of Oxinium is double that of cobalt – chrome

·         Research studies in labs have shown that prosthesis made from OXINIUM reduces wear by 50%.

·         OXINIUM material is less brittle as compared with ceramic there by can reduce risk of brittle fractures.

·         Nickle content in Oxinium is minimal there by reducing the problems of metal sensitivities in certain patients.

OXINIUM KNEE:

In the Oxinium knee the femoral component (Thigh component) is made up of Oxinium.