TKR

Preoperative

Identify high risk groups

- immunocompromised

- diabetes

- RA

- malnutrition

Urine screen

- check for and treat UTi

Groin, nose, axilla swabs

- for MRSA

- if positive, treat

- need 3 consecutive free swabs

3 x chlorhexidine preoperative showers in 8 hours

Admit day of surgery

- check skin for lesions

Types of Instability

1.  AP Instability

2.  Varus Valgus Instability

3.  Global Instability

4. Frank Dislocation

Goal 

Pain relief combined with a balanced range of motion, strength & stability

Indications

Painful arthritic knee

- OA

- RA

Functional limitation

Ideal Patient

- > 65

- thin

Numbers

9 years up to 31 December 2009

- 289 000 TKR

- 80% primary

- 11% primary partial

- 8.5% revision

TKR Revision Rate 

9 year revision rate of 5.1% OA

- 4.5% in RA

Causes

- loosening  30%

- infection   20%

Principle

Correct alignment and soft tissue balancing

- two of the most important aspects of successful TKR

Technical Goals

1.  Restoration of mechanical alignment

- forces of the leg pass through the centre of the hip, knee and ankle