Total Knee Arthroplasty
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, because it's biggest motion is flexion-extension, but rotation is also possible in the knee. 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 makes sure that there is no friction between the bones and it's also a kind of shock absorber. Both the lateral and medial side of the knee, there is a meniscus, which keeps the tibia to the femur, but which 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, and the individual is seriously impaired a total knee prosthesis can be necessary. The main reason for a total knee prosthesis is osteoarthritis.[1] (evidence level: 1b) Because of osteoarthritis, the cartilage of the joint get's damaged and isn't able to absorb shocks anymore. 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 could be rheumatoid arthritis, fractures, or congenital factors. There might also be some genetic factors in the arise of osteoarthritis, but more research is necessary. (evidence level: 2b)
Total knee arthroplasty is mostly performed on women and the frequency of this intervention 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, where it’s about a synovial inflammatory process. Osteoarthritis is the main cause for a total knee arthroplasty.[1] (evidence level: 1b)
Other differential diagnosis:
Rheumatoid arthritis, previous injuries of the knee like the (partial) removal of the meniscus, too much varus of 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]
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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]
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- ↑ 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.
