Total knee arthroplasty/replacement

A 75-year-old woman xmderwent elective total knee arthroplasty xmder general anaesthesia in combination with peripheral nerve blockade. Due to postoperative pain she received nefopam (80mg/24h). One day later she complained of sharp ocular pain and fuzzy vision. As first suspicion was keratitis, she received eye drops. However, a few hours later, she also complained of headache, which was recognized as migraine with ocular aura. At the same time, nefopam was stopped and replaced by tramadol 100 mg. Both tiie head ache and eye pain improved, but did not completely resolve and were discovered six days after surgery to be due to acute angle closure glaucoma [50 ]. 

One of the greatest concerns about the use of PE in joint replacement bearing surfaces is the wear of the material and the effect the wear debris has on the surrounding tissues. For many years, it has been demonstrated that this wear debris leads to osteolysis and loosening of the prosthetic components [21, 25]. Wear of the polyethylene or loosening of the implants, which may be related to wear debris, remains a common reason for revision surgery after total hip [26, 27] or total knee arthroplasty [28]. 

UHMWPE has been used in knee replacements since the late 1960s, when Frank Gunston developed a cemented implant design at Wrightington Hospital [5, 6]. This early knee replacement resurfaced the individual condyles of the femur and the tibia. Total knee arthroplasty (TKA), which replaces the articulation between the femur and tibia, as well as between the femur and the patella, was developed in the 1970s, primarily at surgical centers in North America. The basic anatomical landmarks and implant features of a typical total knee replacement are illustrated in Figure 7.1. 

Hydroxylapatite plasma sprayed coatings have been used in total hip arthroplasties (Jaffe and Scott 1996), dental implants (Ong and Chan 1999), knee replacements, ankle arthroplasties (Zerahn et al. 2000), orthopaedic screws (Magyar et al. 1997), and spinal implants. The most widely used application is the femoral stem where 11 year clinical results show slightly better performance than cemented prostheses (Ravelin et al. 2000). 

Andriacchi T.P., Stanwyck T.S., and Galante J.O. 1986. Knee biomechanics in total knee replacement. /. Arthroplasty 1 211. 

Knee arthroplasty designs from the 1970s. (A) Modified geometric (B) Townley (C) Leeds (D) Total Condylar (E) Charnley load-angle inlay (F) Freeman-Swanson (G) Marmor modular. (Reprinted with permission from Walker RS. 1977. Human joints and their artificial replacements. Springfield, IL CC Thomas Publisher.)... 

Ranawat C.S., H.A. Rose, and W.J. Bryan. 1984. Replacement of the patello-femoral joint with the total condylar knee arthroplasty. Int Orthop 8 61-65. 

Saragaglia, D., et al., Compnter-Assisted Total Knee Replacement Arthroplasty comparison with a conventional procedure. Results of a SO cases prospective randomized trial, in First Annual Meeting ofCAOS International, 2001, Davos, Switzerland. 

Moore DJ, Freeman MAR, ReveU PA et al (1998) Can a total knee replacement prosthesis be made entirely of polymers 1 Arthroplasty 13 388-395... 

Despite the current controversies surrounding the CHARITE, it is nonetheless the icon for contemporary total disc arthroplasty. Other artificial disc designs are currently in chnical use in Europe and may become available in the United States within the coming decade. However, these newer designs build upon the design philosophy established by the CHARITE, which adapted the successful bearing concepts from hip and knee replacements for total... 

Based on the clinical experience of UHMWPE in total hip and knee replacements, the prodnction of wear debris from artificial discs, as well as from other motionpreserving spine implants, is a clinical concern. Wear debris indnced osteolysis has been implicated as a potential mechanism for late onset pain following the faUme of stainless steel and titanium instrumented fusions [65]. Osteolysis has also been observed around certain total disc replacement designs, such as the Acroflex artificial disc [66], and case smdies of osteolysis around CHARITE disc replacements have also been reported [67-69]. According to recent conference presentations, the UHMWPE particle load around long-term implanted artificial discs may be comparable to total hip arthroplasty [70], and the periprosthetic particle concentration appears to be correlated with a local inflammatory response [71]. Although the occurrence of osteolysis with metal-on- X)lyethylene total disc replacements has thus far been relatively rare, the long-term wear behavior of artificial discs remains of clinical importance [69]. 

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