Knee
TKR principles, consent and anaesthesia
Goals and principles of knee replacement, informed consent and anaesthesia choice.
10 questions
3 source pages
2 images
Images appear with the first question taken from each source page — tap a question to open it.
Q1What is the goal of total knee replacement (TKR)?▸
- Painless, stable, mobile joint free of infection
Q2What are the principles of TKR?▸
- Restore mechanical axis
- Restore joint line
- Balanced F/E gaps
- Stable fixation
Q3What are the 90-day complication rates after primary TKR in the US Medicare population?📷▸
- Source: JBJS 2005 (US Medicare population)
- Mortality 0.7%
- Readmission 0.9%
- PE 0.8%
- Wound infection 0.4%
- Pneumonia 1.4%
- MI 0.8%
Q4What are the 90-day complication rates after revision TKR?▸
- Mortality 1.1%
- Readmission 4.7%
- PE 0.5%
- Wound infection 1.8%
- Pneumonia 1.4%
- MI 1.0%
Q5What are the risks in the 90 days after discharge following TKR (JBJS 2006)?▸
- Study of 222,684 patients
- Mortality 0.53%
- Infection 0.71%
- PE 0.41%
Q6What risks do you discuss when consenting for TKR?▸
- Anaesthetic risk
- Intra-op: bleeding, nerve/vascular injury, fracture
- Post-op: infection (wound, deep, urine), DVT/PE, pneumonia, aseptic loosening
Q7Would you consider bilateral TKR in the same OT and why?▸
- Yes if the patient is fit
- Overall less complications
- Post-op may need ICU/HDU care
- More difficult to rehab
- Not everyone progresses to a 2nd TKR
Q8What are the short-term (30-day) outcomes of spinal versus general anaesthesia in TKR?📷▸
- JBJS 2012 evidence
- Less superficial infection
- Less transfusion
- Shorter OT time
- Shorter length of stay
- Especially in those with comorbidities
Q9Which anaesthetic technique is preferred for total knee replacement?▸
- Spinal anaesthesia - less superficial infection, less transfusion, shorter OT time and shorter length of stay at short term (30 days)
- Based on JBJS 2012
Q10In which patient group is the benefit of spinal anaesthesia greatest?▸
- Especially in those with comorbidities