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
1. AP Instability
2. Varus Valgus Instability
3. Global Instability
4. Frank Dislocation
Pain relief combined with a balanced range of motion, strength & stability
Painful arthritic knee
- OA
- RA
Functional limitation
Ideal Patient
- > 65
- thin
Metabolic Bone Disease
Paget's
Fracture Malunion
Previous Osteotomy
1. Intra-articular correction
2. Simultaneous osteotomy and TKR
3. Staged correction and TKR
Femur
- draw line of mechanical axis of femur
9 years up to 31 December 2009
- 289 000 TKR
- 80% primary
- 11% primary partial
- 8.5% revision
9 year revision rate of 5.1% OA
- 4.5% in RA
Causes
- loosening 30%
- infection 20%
Correct alignment and soft tissue balancing
- two of the most important aspects of successful TKR
1. Restoration of mechanical alignment
- forces of the leg pass through the centre of the hip, knee and ankle