Total Knee Arthroplasty
Thomas S. Thornhill, MD; David J. Lee, MD
Brigham and Women’s Hospital
Total knee replacement is one of the most common orthopaedic procedures performed in the United States. The most common indication for total knee replacement is osteoarthritis. Clinical signs of knee osteoarthritis include pain with walking, difficulty ranging the knee, knee instability, varus deformity, bony enlargement, extension lag, and flexion contracture. Radiologic evidence for osteoarthritis of the knee includes the presence of osteophytes, joint space narrowing, subchondral sclerosis, subchondral cysts, and malalignment.
Before considering total knee replacement, patients typically undergo a trial of less invasive treatments, including lifestyle modification, pharmacologic therapy, and injections. If these methods fail to produce satisfactory improvement in the patient’s symptoms, one should consider the benefits and risks of total knee replacement in conjunction with their surgeon. Outcomes following total knee replacement are excellent, with patients reporting greatly reduced pain, improved mobility, and improved quality of life. However, patients must be aware that there are serious risks that accompany any surgery, which include infection, pulmonary embolism, deep vein thrombosis, nerve damage, and need for further procedures.
Mako Robotic Arm Assisted Total Knee Arthroplasty
Tufts Medical Center
Jeffrey S. Zarin, MD
Chief, Division of Arthroplasty
In this case a 66-year-old patient presents with arthritis predominantly in the medial compartment. Dr. Jeffrey Zarin explains how to use the Mako robot to precisely plan and perform a total knee arthroplasty surgery on this patient. Preoperatively, he uses a CT scan to create a model of the patient in order to determine the appropriate implant size, and intraoperatively, he utilizes the Mako robot to assist in ligament and gap balancing, perform the osteotomies, and make precise corrections.
Posterior Cruciate-Retaining Total Knee Arthroplasty
Richard Scott, MD
Professor of Orthopaedic Surgery, Emeritus
Harvard Medical School
Abstract: Total knee arthroplasty has evolved into a very successful procedure to relieve pain and restore function in the arthritic knee with advanced structural damage. Optimal results are dependent on the restoration of alignment and ligament stability. Operative techniques involve either preservation of the posterior cruciate ligament or substitution of its function through increased prosthetic constraint. The vast majority of knees do not require cruciate substitution to establish appropriate stability and function. This video outlines the operative technique used by the author for posterior cruciate-retaining total knee arthroplasty in a patient with a preoperative varus deformity.
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