Total Knee Arthroplasty: Difference between revisions
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== Differential Diagnosis | == Differential Diagnosis == | ||
<u>Osteoarthritis:</u><br>Osteoarthritis is a degenerative process at the level of the cartilage and should be well distinguished from arthritis, | <u>Osteoarthritis:</u><br>Osteoarthritis is a degenerative process at the level of the cartilage and should be well distinguished from arthritis, which is about a synovial inflammatory process. Osteoarthritis is the main motivation for total knee arthroplasty. <ref name="Skou et al.">Skou, Søren T., et al. "A randomized, controlled trial of total knee replacement." New England Journal of Medicine 373.17 (2015): 1597-1606.</ref> (evidence level: 1b) | ||
<u>Other differential diagnosis:</u><br>Rheumatoid arthritis, previous injuries | <u>Other differential diagnosis:</u><br>Rheumatoid arthritis, previous injuries to the knee occasioning, for example, the (partial) removal of the meniscus, too much varus or valgus of the knee,... <br> | ||
== Diagnostic Procedures == | == Diagnostic Procedures == |
Revision as of 22:28, 29 May 2016
Original Editors
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Search Strategy[edit | edit source]
Medical databases: Pubmed, PEDro, Web of Science
Keywords searched: Total knee arthroplasty, knee osteoarthritis, rehabilitation AND TKA, the knee joint, etiology AND TKA, total knee replacement,...
Books: Total Knee Arthroplasty. A Guide to Get Better Performance. Johan Bellemans, Michael D Ries, Jan MK Victor.
Definition/Description[edit | edit source]
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Clinically Relevant Anatomy[edit | edit source]
The knee is a hinge joint (articulatio gynglymus). This type of joint permits motion in only one plane. The knee is a special hinge joint; its principal motion is flexion-extension, but rotation is also possible. There are three bones that form the knee joint: the upper part of the tibia , the lower part of the femur and the patella. The bones are covered with a thin layer of cartilage, which ensures that there is no friction between the bones and also acts as a kind of shock absorber. On both the lateral and medial sides of the knee, there is a meniscus, which adheres the tibia to the femur, but is also a shock absorber. The three bones are kept together by ligaments and are surrounded by a capsule.
Epidemiology /Etiology[edit | edit source]
When all the compartments of the knee are damaged, a total knee prosthesis may be necessary. The main cause of need for a total knee prosthesis is osteoarthritis. [1] (evidence level: 1b) Because of the presence of osteoarthritis, the cartilage of the joint becomes damaged and is no longer able to absorb shocks. There are a lot of external risk factors that can cause knee osteoarthritis. For example: overweight, previous knee injuries, the (partial) removal of a meniscus,... [2] (evidence level: 2a) Other causes are rheumatoid arthritis, fractures and congenital factors. There might also be some genetic factors in the development of osteoarthritis, but more research is necessary. (evidence level: 2b)
Total knee arthroplasty is mostly performed on women and increases with age.[2]
Characteristics/Clinical Presentation[edit | edit source]
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Differential Diagnosis[edit | edit source]
Osteoarthritis:
Osteoarthritis is a degenerative process at the level of the cartilage and should be well distinguished from arthritis, which is about a synovial inflammatory process. Osteoarthritis is the main motivation for total knee arthroplasty. [1] (evidence level: 1b)
Other differential diagnosis:
Rheumatoid arthritis, previous injuries to the knee occasioning, for example, the (partial) removal of the meniscus, too much varus or valgus of the knee,...
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
- Knee disability and Osteoarthritis Outcome score (KOOS) to see if there are any difficulties in the execution of daily activities.
- The Timed Get Up and Go Test (TUG) to see whether the patient is able to walk independently after the surgery or if he needs a walking aid.
- Visual Analogue Scale (VAS) to have an idea about the degree of pain the patient is going through.
(also see Outcome Measures Database)
Examination[edit | edit source]
Pre-operative tests
First the examiner should ask the patient about the history of complaints and also about the expectations of the surgery. Than he can perform an inspection of the knee (compared to the other knee) and the body position in general.
After this you could use different tests to test whether the patient needs a total knee arthroplasty:
- Active research to have a proper image of the patients functioning.
- Passive research: flexion/extension range of motion measured by a goniometer. The preoperative ROM is a strong predictor of the postoperative ROM after TKR.
- Muscle function examination.
Post-operative tests[3]
- Inspection: of the wound/scar, redness, adhesion of the skin. When an infection of the wound is suspected the patient has to go to an orthopedist or to an emergency doctor.
- Palpation: post-operative swelling, hypertonia (adductors), pain and warmth.
Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 Skou, Søren T., et al. "A randomized, controlled trial of total knee replacement." New England Journal of Medicine 373.17 (2015): 1597-1606.
- ↑ 2.0 2.1 Blagojevic, M., et al. "Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis." Osteoarthritis and cartilage 18.1 (2010): 24-33.
- ↑ Jakobsen, Thomas Linding, et al. "Early Progressive Strength Training to Enhance Recovery After Fast‐Track Total Knee Arthroplasty: A Randomized Controlled Trial." Arthritis care & research 66.12 (2014): 1856-1866.