Total Knee Arthroplasty: Procedure and Rehabilitation

What is the mainstay treatment for end-stage osteoarthritis (OA) and rheumatoid arthritis (RA)?

Total Knee Arthroplasty (TKA)

In what cases might TKA also be indicated aside from OA and RA?

Certain cases of severe trauma or cancer.

What are the joint surfaces involved in TKA resection?

Distal femur, proximal tibia, and posterior patella.

What materials are used to replace the resected joint surfaces in TKA?

Metal and polyethylene prosthetic components.

How are the prosthetic components fixed in place during TKA?

Cemented in place with polymethyl methacrylate.

What is a benefit of using porous coated prosthesis in younger patients undergoing TKA?

It is press fit into the residual bone.

What is a common reason for the failure of cemented TKAs?

The bone cement wears down over time.

What are the benefits of uncemented components in TKA?

They provide a more durable bone-prosthetic interface and ease of revision.

How long do patients typically stay hospitalized after TKA?

About 2-3 days.

What is the role of preoperative rehabilitation for TKA patients?

It is cost-effective and should include education and exercise.

What key topics should be covered in patient education before TKA?

Procedure details, patient expectations, likely outcomes, preoperative rehab, mobility training, postoperative positioning, and discharge planning.

What components should an exercise program for TKA patients include?

Strengthening, range of motion (ROM), immediate postoperative exercise, deep breathing, ankle pumps, and quad sets.

What screening should be performed prior to TKA?

Screening for depression.

When can postoperative rehabilitation begin after TKA surgery?

As soon as the day of surgery, but no later than 24 hours after.

What are some components of postoperative rehabilitation for TKA?

Cryotherapy, early aggressive knee PROM, AAROM, AROM, quad NMES, progressive high-intensity LE resistance exercise, balance exercise, and mobility training.

What is arthrofibrosis in the context of TKA?

Excessive scar tissue formation limiting motion, which may require surgical release and manipulation under anesthesia.

What is the goal for knee range of motion in the first week post-TKA?

0-90 degrees, with a long-term goal of 0-110 degrees or more.

What should clinicians avoid using for patients with uncomplicated TKA?

Continuous passive motion machines.

Which assessments should clinicians use to plan interventions and track changes over time for TKA patients?

Berg balance test, Time up & go, and 30 sec Sit-to-stand.

What patient-reported outcome measures are relevant for TKA?

WOMAC, Knee Injury & OA Outcome Score (KOOS), and Short Form 36.

What outcomes can patients expect after undergoing TKA?

Reduction in pain, increased knee ROM, improved function, and enhanced sense of well-being.

What is the average life expectancy of a TKA?

Around 25 years.