OSTEOARTHRITIS WITH TOTAL KNEE

REPLACEMENT/ARTHROPLASTY

RIDUAN ADIANSYAH
 The main parts of the knee joint are bones, ligaments, tendons,
cartilages and a joint capsule, all of which are made of collagen.
Collagen is a fibrous tissue present throughout our body. As we age,
collagen breaks down.
There are 5 ligament in knee Joint :
- Medial Collateral Ligament
- Lateral Collateral Ligament
- ACL
- PCL
- Patellar Ligament
 CHRONIC PAIN

The most common causes :

1. Osteoarthritis
2. Rheumatoid Arthritis
3. Post-Traumatic Arthritis
OA = is a chronic joint disorder in which there is progressive softening and
disintegration of articular cartilage accompained by new growth of cartilage
and bone at the joint margins (osteophytes) and capsular fibrosis

Primary
- Change in cartillage matrix
- Crystal deposition desease
and ochronosis
- Genetic defects in type II
collagen
Secondary
- Articular cartilage may be
damaged by previous
inflammatory disorder
- It’s just like OA with
previously Rhematoid
Arthritis
Risk FACTORS AND CLINICAL FEATURES
- Stiffness is common; characteristically it occurs
 Joint dysplasia Disorders
 Trauma after periods of inactivity, but with time it becomes

 Occupation constant and progressive.

 Bone Density
 Obesity
 Family History
- Swelling may be intermittent (suggesting an
effusion) or continuous (with capsular thickening
or large osteophytes).
- Deformity may result from capsular contracture
or joint disability; but beware, it may have
preceded and contributed to the onset of OA.
- Loss of function
GRADING OF OA
Typical radiographic by Kellgren & Lawrence 1957:
• Grade I : normal joint, minimal osteophyte
• Grade II : definite osteophyte on two places with
subchondral sclerosis, normal joint space, subchondral cyst
• Grade III : moderate osteophyte, deformity of bone margin, narrowing of
joint space
• Grade IV : major osteophyte, narrowing of joint space (+), Sclerosis( + )
 THE PRINCIPALS OF TREATMENT
• Mantain movement and muscle strenght
• Protect the joint from overload
• Relieve Pain
• Modify daily activities
NON OPERATIVE TREATMENT
 Total Knee
Replacement/Arthroplasty

This is more accurate term, a “knee

resurfacing”, because only surface of the
bone are actually replaced
 • limits your everyday activities, including walking, climbing stairs, and WHEN THE
Severe
knee pain
getting in and out of chairs, hard to walk more than a few blocks SURGERY IS
or stiffness NEEDED?

• a bowing in or out of your knee

Knee
deformity

• Either night or day

Pain While
Resting

• Such as :Anti inflammatory, cortisone injections, lubricating

Failure w/ injections, physical therapy
treatment
4 basic step of TKR
Procedure
1. Prepare The Bone
2. Position The Metal
Implant
3. Resurface the Patella
4. Insert A Spacer
WHAT WE EXPECTED

- a significant
improvement in the Excessive activity or
ability to perform With normal use and weight may speed up
But, TKR not allow activity, every knee this normal wear and
common activities you to do more than
of daily living. replacement implant may cause the knee
you could before
developing arthritis begins to wear in its replacement to
- Experience a plastic spacer loosen and become
dramatic reduction
painful
of knee pain
PERMIT AND PROHIBIT

PERMIT
• unlimited walking, swimming,
golf, driving, light hiking,
biking, ballroom dancing, and
other low-impact sports
PROHIBIT
• running, jogging, jumping, or
other high-impact sports
 PATIENT STATUS
a) Name : Mr. S
b) Age : 67 years old
c) Sex : MALE
d) Address : Pegandon, Kendal
e) Room : Anggrek
f) Register Number : 499491
g) Date of entry : 17/07/2018
Present Status
A man came to the orthopedic clinic complaining of pain and stiff in the right knee
since ± 1 years before entry hospital. Pain is felt like needles, continuously and
increasingly in ± 1 month before entry hospital, so that patients complain of difficulties
in the move and walk even in routine essential activities. Patient also felt stiffness
every morning on the right knee. Patient never got same illness like this before. The
same illness on his family has been denied. This patient covered by BPJS.
 PHYSICAL EXAMINATION

VITAL SIGN
• Head : Mesocephal, Wound (-)
· HR : 97 x/m • Eyes : Anemis -/-, Icteric -/-

• Ear : Discharge -/-

· RR : 23 x/m • Nose : Deviation septum -/-, discharge -/-

• Mouth : Bleeding (-)

· to : 36,7o • Neck : Simetris, Trachea deviation (-)

• Thorax : Normochest, simetris

· BP : 190/110 • Abdomen : Normal

• Back : Normal
• Extremity :
Superior Inferior

Akral -/- -/-

Oedem -/- -/-

Capillary refill <2” <2”

lession -/- -/-

Hematom -/- -/-

 Localized Status
Right knee Left knee Hyperextension (-) (-)

kin condition Eritema (-) Eritema (-) Varus/Valgus

(-) (-)
deformity
welling (-) (-)
Ligament laxity (-) (-)
uadriceps
(-) (-) Range of motion
asting Restricted Normal
(ROM)
ocal
Warm Normal
mperature

nderness (+) (-)

epitus (+) (-)

xed flexion
(-) (-)
formity (FFD)
 Reference
Hematology Result
value

Hemoglobin 14.7 gr/dL (L) 11.5 – 16.5

Leukosit 7.2 10^3/uL 4.0 – 10.0

Trombosit 278 10^3/uL 150 – 500

Hematokrit 44.9 % (L) 35.0 – 49.0

PT 12,5 detik 11,3 – 14,7

APTT 31,0 detik 27,4 – 39,3

RADIOLOGY
 DIAGNOSE
• Osteoarthritis of the Knee Dextra grade III
 INITIAL PLAN
• MEDICAL TREATMENT • Operatif
• Inf. RL 20 tpm • Total knee replacement
• Inf. Cefazolin 2x1 gr
• Inj. Dexketoprofen 2x50mg • Monitoring
• Inj, Ranitidine 3x50mg • General situation
• Amlodipin 10mg 0-0-1 • Vital sign
• Irbesartan 300mg 1-0-0 • Drain
• Levfloxacin 1x500 (post op) • ROM exercise
• Dex ketoprofen tab
2x25mg(post op)
 PROGNOSIS
• Quo ad vitam : ad bonam
• Quo ad sanationam : ad bonam
• Quo ad fungsionam : ad bonam