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KMID : 0381219880200040400
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Journal of RIMSK
1988 Volume.20 No. 4 p.400 ~ p.408
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Total Knee Arthroplasty
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Abstract
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The art and science of total knee arthroplast (TKA) has come a long way in the last 15 years. TKA has become highly regarded and frequently recommended procedure. However, some of the uncertainties of the past about selection of design and also some of the technical controversy continue today.
When we are doing TKA, we have to strictly follow up the principles of TKA. The principle of TAK include 1) alignment of the knee in the anteroposterior, lateral and coronal planes; 2) proper soft tissue balance of the medial, lateral, and posterior capsular structures so the joint is stable in both flexion and extension; 3) good cement technique which allow 2-5 mm of cement penetration into cancerous bone; and 4) accurate alignment of the quadriceps mechanism so the patella rides in the femoral groove.
If the principles of technique are respected, the narrow limits for margin of error can be met. To provide optimal results, the following measures are recommended. The tibia should be cut no more than 5 mm from the medial subchondral bone, if posterior cruciate ligament is sacrificed, and between 5 mm and 8 mm, if the posterior cruciate is saved. Fill a defect as necessary with bone graft. The tibia should be cut 90° to its axis in the medial-lateral plane and with 2°-5˚ posterior tilt. Maintain the anterior-posterior height of the femur to ensure flexion stability. Use the distal femur as the adjustment cut even if the joint line is elevated. If the posterior cruciate ligament tension is tight, lengthen the ligament or convert to a sacrificing design or sacrificing the ligament. Deformity should be corrected with soft tissue release and not angular bone cuts. The patella cut should be performed so that the result is a symmetrical patella that is not increased from its anatomical height. If these principles are followed, the instrumentation use and order of ostetomy of the distal femur or tibia do not matter.
The major mechanism of failure in TKA are loosening, instability, sepsis, extensor mechanism power loss, poor range of motion, bone fracture. These are, for the most part, within the surgeon´s control. Prosthetic alignment is the most important factor influencing postopreative loosening and instability. Clinical results with current resurfacing components TKA rival or exceed those obtained with conventional total hip replacement in properly selected patients. According recent literatures, the survivorship is over 94% 11 years after operation.
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