ARTICLES » Total Knee Arthroplasty Today

DR. BARRY D’ ROSARIO
Director - Department Of Knee Replacement Surgery - MIOT Hospitals and
Members of the Board of Trustees - IGOF

 

Total Knee Arthroplasty Today
On the eve of the 10th Anniversary of MIOT Hospitals, it augurs even better outcomes for every patient who undergoes Total Knee Arthroplasty. We are the one of the few centres in India which has started using the new, “High Performance Instruments” which has been released globally this year.

 

These instruments are used with Computer Navigation to ensure more precise and accurately placed cuts in the bone and an excellent fit of the implants, thereby enhancing the longevity of the implanted knee.

 

Computer navigation is done using the Ci-Computer and Camera System. This system ensures that the bony resections are made with almost 0° error. It also places the knee in the exact axis and permits excellent soft tissue balancing. All of this ensures long term survival of the implanted knee.

 

Over the last 10 years, we have operated at the rate of over 500 TKR’s per year. We continue to treat an increasing number of patients with very severe deformity and instability. The deformity varies and is usually from untreated or neglected cases. It can be severe flexion deformity or very severe varus and valgus deformities.

 

We have a wide variety of implants to treat the entire spectrum of cases:

 

The PFC knee is the usual knee used in the elderly with a fixed bearing. The latest version has a tibial tray made from highly polished cobalt chrome and a 5 Mega Rad Cross linked Polyethylene insert which is locked in by a 12 point system. It has an extremely low wear rate and excellent function. Flexion to 130 degrees is not uncommon.

 

The RPF knee is a mobile bearing knee with a specially designed geometry of the posterior condyle and the Cam Mechanism which permits the individual to have 150 degree of flexion. These knees are implanted in patients who demand high function from the knee.

 

An increasing number of patients expect to take part in recreational activities, sport, religious activities and hobbies which require a high range of flexion in the knee.

 

The TC3 knee is for patients with very severe deformity in the knee. In bony defects, the TC 3 is very useful. The bony defects can be made good with metal wedges of different thickness and sizes and the stability of the femoral and tibial implants augmented by intramedurally stems which can be implanted cemented or uncemented.

 

Femoral and Tibial Metaphyseal sleeves: A radical new innovation is the use of pre-formed femoral and tibial metaphyseal sleeves of different sizes to fill large proximal bone defects. These can be used along with the regular prosthesis. They are extremely useful and stable especially in a Revision situation.

 

Revision Knee Replacement: For aseptic loosening or mechanical wear in Total Knee Replacement, excellent components exist to revise these knees and give the patient a new lease of life. The TC3-RP Revision knee with a rotating platform offers a wide spectrum of solutions.

 

If there is associated severe ligamentous instability, use a Constrained Knee like the S.Rom, Noiles knee.

 

Extremely low infection rate: Coupled with modern laminar flow operation theatres and a state of the art CSSD like Getinge-Sweden, an infection rate that is less than 0.5% is achievable.

 

International knee Society score. All our patients are examined for their preoperative knee score and knee functional score which are stored in the computer. All patients are again examined and evaluated post operatively as out patients and scored for the next 5 years.

 

We now perform an average of 5 to 6 TKR’s daily and therefore with this vast experience we are sure we will be able to give a patient who needs TKR an excellent functional knee using a Minimally Invasive technique.