Write the Talk

Dr. S. Chockalingam

Senior Consultant – Orthopaedic Surgeon, Kauvery Hospital, Trichy, India

*Correspondence: smch17@gmail.com

Dr Chokalingam

Gist of the talk given by Dr Chockalingam at Salem Arthroplasty conference on 6th August 2022.

Total knee replacements are one of the commonest orthopaedic operations performed worldwide in an elective setting. This surgery is a specialised surgery and the success of this surgery depends not only on the immediate pain relief but also on having a long-term survival of the prosthesis implanted with good pain relief and function.

Complications from this surgery can either be medical or surgical related to the surgery itself. However, there is a set of patients on whom a specific complication cannot be determined on a cursory examination of the patient or the x-ray.

These patients do have good pain relief from their arthritic pain but are unhappy about their new knee.

The percentage of patients who are unhappy about their new knee can be as high as one in four patients.

The talk given at Salem focuses on this subset of patients who are unhappy about their new knee

Unhappy total knee replacement patients

Summary

We have to understand that pain relief and improvement of function with total knee replacement alone do not make all patients happy about their new knee.

The surgeons can control some of the causes of this to prevent and treat this problem.

Definition

Successful total knee replacement patients with no infection, and complete pain relief from arthritic pain, yet not entirely happy with their new knee:

Incidence

Commonly one in six patients after uncomplicated surgery, but can be as high as one in four.

Clinical presentations

1. Inability to achieve full knee extension

2. Anterior knee pain

3. Clicks and clunks

4. Recurrent swelling

5. Difficulty in climbing stairs

6. Difficulty in getting up from a chair

7. Recurrent instability or patellar dislocation

Causes

1. Implant factors

2. Technical factors

3. Patient factors

Evaluation

1. Normal post-op recovery after total knee replacement should be understood

2. Clinical evaluation of the patient which includes spine, hips and the specific knee

3. Evaluation for infection is important

4. Appropriate x rays

5. CT scan for assessment of component placement

Prevention and Treatment

1. Prepare the patient for normal post-op recovery

2. Adequate rehabilitation

3. Prevention of technical errors

4. Use of modern prosthesis at time of surgery

5. Treatment instability and dislocation with ligament repair with specialized techniques

6. Use of open arthroscopic technique to treat clunk

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