Kumpulan jurnal

Juvenile Arthroplasty
• Debilitating disease, affects px 16 yo and
younger
• Bimodal, peak onset 8 yo and during
puberty
• Poor overall prognosis in term of pain and
function
• 50 %  will eventually have active arthritis
• Early stage : soft tissue release +
synovectomy
 TKA in Juvenile RA
• For advance osseous destruction
• Enhance function and independence
• Implants longevity due to decreased level
of physical activity

(JBJS Jul 2005, 87, 7 pg 1510)

 TKA & Hemophilia
• Knee  most commonly involved joints
• End stage  Synovial tissue change to
fibrous tissue
• Rate of prostetic survival after 5 yrs : 90 %

• (JBJS, Jan 2005, 87,1 pg 85)

 Unicompartmental Knee
Arthroplasty
• Indications  Kozin & Scott criteria :
– Unicompartmental OA / osteonecrosis
– Radiographic evidence of preservation of the opposite
compartment
– Mild radiographic signs of deterioration of
patellofemoral joints
• Knee flexion after 10 yr follow up :
average 1210, (range 100 – 1400)
• 13 yrs survival rate for revision : 96 %

(JBJS, May 2005, 87,5 p999)

 Goal of Treatment for RA
• Complete suppression of synovitis
• Reduction in radiographic damage
• Reduction of disability
• Reduction of deformity

(Rheumatology 2001:40:1211-1220)
 Why treating early ?
• Damage occurs early
– Radiographic
– Loss of function
– Lost of BMD
• Subclinical disease
– MRI and Ultrasound can detect synovitis on
‘normal’ joints
• Remission is rare
(Rheumatology 2001:40:1211-1220)
 Indication
• Relief of pain  severe daily pain, fail on
non operative management
• Restore stability
• Restore deformity  BMI>30%
• Radiological anomaly  x ray evidence of
narrowing of the joint space
 Contra Indication
• Absolute contraindications to total knee replacement :
1. Knee sepsis including previous osteomyelitis,
2. Remote source of ongoing infection,
3. Extensor mechanism dysfunction,
4. Severe vascular disease,
5. Recurvatum deformity secondary to muscular weakness,
6. The presence of a well functioning knee arthrodesis.

• Relative contraindications :
1. Medical conditions that preclude safe anesthesia,the demands of
surgery and rehabilitation.
2. Skin conditions within the field of surgery e.g psoriasis
3. Neuropathic joint and obesity.
4. The absence of Anterior Cruciate Ligament (ACL).
Riaz S & Maistrelli GL, Unicompartmental Knee Arthroplasty and its Minimally Invasive Version, Pakistan
Journal of Medical Science: 2005; 21(3); 237-246
 Timing of surgery
• In terms of the timing of TKR surgery, 2 studies found
that the severity of osteoarthritis does not predict
outcome, but 1 study was found that higher functioning
patients had significantly less pain and better function up
to 2 years after surgery compared with lower functioning
patients.
• It is important to note that the patients in the low and
high function groups were evenly matched on comorbid
conditions.
• In terms of age, 40% of TKR surgeries were performed
in patients aged 65 to 74 years, 8% were performed in
patients younger than 55 years, and 3% were for
patients older than 85 years.
 Results based on objective and functional
assessments
Before and after knee replacement

Knee score
Maximum possible Before knee replacement At 2 years

Function 100 46.6 74.6

Pain 50 12.7 42.7

Overall* 100 47.3 83.0

John A L Hart Bone and Joint Disorders: Prevention and Control Joint replacement surgery : MJA2004;
180 : S27-S30
 Timing
Late Moderate
QWB 0.530 0.592
WOMAC 16.7 29.9
• QWB : Quality of Well Being Index (0 – 1)
• WOMAC : Western Ontario and McMaster University Osteoarthritis
Index

…waiting too long definitely produces suboptimal outcome …

early surgical intervention may result in better surgical
outcomes that endure for years …
(Brandys, J. AAOS Bulletin, March 22-25 2006)