Tyler Jones, MD

Knee JointReplacement

Normal/Abnormal Joint Function

Symptoms of Joint DisordersTreatments

Topics

Femur (Thighbone)Supports the weight of the upper body at both the hip and the knee

Tibia (Shinbone)Supports the weight of the upper body at the knee and the foot

The Bones of the Leg

FibulaSmaller bone, always on the outside of the leg

Patella (Kneecap) Provides a fulcrum for the muscles of the upper leg to efficiently move the lower leg

The Bones of the Leg

Femur

Anatomy of the Knee

Patella

Tibia

Rounded prominence at the end of the femur

Provide smooth rocking movement

Help distribute the weight of

the upper body

Condyles

Condyles

Anatomy of the Knee

Strong bands of tissue

Stabilize the jointOutside the knee

Medial CollateralLateral Collateral

Inside the kneePosterior CruciateAnterior Cruciate

Four Major Ligaments

Ligament

Anatomy of the Knee

Ligament

Rubbery tissue found in joints

Cushions and Protects the ends of bones

Provides smooth gliding surface for bones

Cartilage

Cartilage

Anatomy of the Knee

Arthritis

Defined as inflammation of the joint

Over 100 different types Affects 43 million Americans each year

Arthritis

Osteoarthritis Rheumatoid arthritis

Two Primary Types of Arthritis

Rheumatoid Arthritis

Affects about 2.5 million Americans annually

Can be a particularly disabling disease

Can seriously limit a person’s well-being

Rheumatoid Arthritis

Inflammatory joint conditionThe joint’s lubricating fluid (synovial fluid) increases pressure inside joint

Synovium thickens and begins to erode the cartilage

Usually affects more than one joint at a time

What is Rheumatoid Arthritis?

Osteoarthritis

Most common type of arthritis

Affects 23 million Americans

Osteoarthritis

Degenerative disease affecting joint cartilage“Wear and tear”

A manageable, treatable condition

What is Osteoarthritis?

Osteoarthritis

Normal Knee X-ray

Arthritic Knee X-ray

PainJoint SwellingStiffnessDecreased activityImpaired lifestyle

Symptoms of Arthritis

Decreased range of motion

Joint-line tendernessJoint deformities

Physical Examination

Joint space narrowing

Abnormal bone formation “spurs”

Joint DeformityBowlegKnock knee

X-ray Analysis

Treatments

DietModerate

ExerciseWalking

DevicesBraces

Treatments

IceMedicationInjectionsArthroscopySurgery

Good nutrition promotes overall good health

Excess weight places excess pressure on joints and can lead to or aggravate osteoarthritis

Diet

Exercise improves joint mobility

Physical therapy may help keep joints flexible and mobile

Exercise can help strengthen muscles and provide support for joints

Exercise/Physical Therapy

Cane or walker may help reduce pressure and pain on affected joint

Braces can help support or align joints to relieve pressure and pain

Wedges may transfer force away from affected area

Treatments

Tylenol XSNSAIDs and salicylates

Anti-inflammatory medicationsCox 1 vs. Cox 2

AnalgesicsPain relievers

CorticosteroidsSynthetic form of naturally

occurring substanceMay only be used for short periods

of time

Pain Management with Medication

CortisoneDecrease inflammationMay reduce need for oral

medicationsContraindications

Active local infection Use caution if taking blood

thinning medicinesNot recommended earlier than

every 3-4 months

Injections

Hyalgan or Synvisc OnePurified sodium hyaluronateComes from rooster combsActs like a lubricant or shock

absorber

In OsteoarthritisDecreased quantity of

hyaluronatePossible change in quality of

hyaluronate

Viscosupplementation

ContraindicationsAllergic to Hyalgan, Synvisc One

or similar materialLocal infection at injection siteIf allergic to bird products

Feathers, eggs, poultryPregnant women or nursing

mothersHas not been tested in them

Viscosupplementation

GlucosamineChondroitin

Nutritional Supplements

ArthroscopyUnicompartmental Knee Replacement

Total Joint Replacement

Surgical Options

Arthroscopy

UnicompartmentalImplants

Total Knee Replacement Surgery

Pain negatively affects daily living

Conservative treatment options fail to provide adequate relief from symptoms

Extensive cartilage damage and/or joint deformity

When Should Total Joint Replacement be Considered?

Damaged bone resurfaced with components made from metal alloy and polyethylene (plastic)

Advances in medical technology have helped make outcomes more predictable and acceptable

Total Knee Replacement

Polyethylene wear

Bone lossLoosening

Problems

Primary Knee Components

Femoral ComponentPolyethylene Bearing

(Acts as cartilage)Tibial Tray

(supports polyethylene bearing)

Can eliminate or reduce joint pain

May enhance movement and mobility

Can improve quality of lifeReturn to normal activityLow impact sports and activities

Benefits of Total Joint Replacement

Hospital stay between 3 and 5 daysAssisted walking within 24 hours of

surgeryPain medicationPhysical therapy

Key to recovery Help prevent swelling,

stiffness, and pain Regain strength

and mobility

After Joint Replacement Surgery

Routine Activities (4-6 weeks) Walking (un-assisted), Driving,

Gardening, Shopping, Housework

Resume Usual Activities

Low-Impact Activities (2-3 months) Golfing, Dancing,

Bowling, Swimming, Bicycling

Resume Usual Activities

RunningJumpingJoggingHigh-impact or contact sports

Heavy manual labor

Restrictions

InfectionDislocationWear/looseningOther

Possible Complications

Described by PhysicianSupervised Physical Therapy for 4-6 weeks

Home exercise program as directed by physician

Physical Therapy

Medications for Comfort While Healing

ExerciseHealthy Diet

Home Care

6 weeksSet schedule

first yearAnnually

regularly checking the joint will assist in preventing complications

Follow-up Visits with Your Physician

Your symptoms should be diagnosed to help you get relief

Joint replacement patients should follow-up with their surgeon

Osteoarthritis and Rheumatoid arthritis are treatable, manageable conditions

Closing

Questions

Thank You