-Knee Arthroplasty

Osteolysis in TKR

Courtesy: Dr Ranawat, Ashok Shyam TV, Ortho Background Osteolysis remains a significant long-term complication in total knee arthroplasty (TKA). Strongly associated with: Polyethylene wear debris Modular implant designs Historically uncommon in: Fixed-bearing, monoblock all-polyethylene tibial components. Historical Perspective All-Polyethylene Fixed-Bearing Knees Single-unit tibial component. Long-term data (up to 20+ years): Minimal to no osteolysis reported. […]

Painful and Stiff Knee

Courtesy: Dr T Vail, Ashok Shyam TV, Ortho Overview TKA is successful in ~95% of patients. The remaining 2–5%: Experience pain, stiffness, or dissatisfaction. Often consume a disproportionate amount of clinical time. Typical scenario: Radiographs appear normal. Patient reports the knee “just doesn’t feel right.” Clinical Presentation Patients may report: Stiffness Swelling Limited flexion […]

Mobile Bearing TKR

Courtesy: Dr Maniar, Ashok Shyam TV, Ortho Why Consider a Mobile-Bearing Knee? Primary concern: Polyethylene wear: At the articular surface At the undersurface (backside wear) Fixed-bearing knees have demonstrated: Significant articular wear. Undersurface micromotion leading to wear debris. Associated osteolysis and revision in mid-term follow-up. Problem 1: Articular Surface Wear Contact Stress Principle Contact stress […]

Cruciate Retaining TKR

Courtesy: Dr A Reddy, Ashok Shyam TV, Ortho Introduction Focus: Cruciate-retaining (CR) total knee arthroplasty. Personal practice preference: ~99% of primary TKAs performed as CR knees. Used even in severe deformities. Transition from posterior-stabilized (PS) to CR: Smaller knee sizes. Thinner femoral condyles. Concerns regarding box cuts in smaller bone stock. Why Choose Cruciate Retaining? […]

Early TKR Failure-Common Mistake

Courtesy: Dr C Ranawat, Ashok Shyam TV, Ortho Foundational Premise We can always improve surgical outcomes. Most complications occur because of preventable errors. Understanding common technical mistakes helps reduce failures. Common Causes of Surgical Errors 1. Poor Exposure Limited visualization leads to “guesswork.” Small-incision approaches may: Compromise rotational alignment. Leave retained cement (especially posterolateral corner). […]

Prevention of Infection in TKR

Courtesy: Dr S Macdonald, Ashok Shyam TV, Ortho Why This Matters Incidence of infection after TKA: ~1% to 2.5%. Devastating complication: Severe patient morbidity. Surgeon burden. High healthcare cost. Prevention requires a multifactorial strategy: Patient factors Intraoperative factors Postoperative factors 1 Patient-Related Risk Factors Some modifiable, some not. Gender Large registry data (e.g., Finnish arthroplasty […]

Correction of Flexion Contracture in TKR

Courtesy: Dr S Macdonald, Ashok Shyam, Ortho TV Flexion contracture is frequently encountered in advanced osteoarthritis—particularly in populations presenting late. It significantly affects gait mechanics and functional recovery. Why It Matters Flexion contracture increases quadriceps workload. Bilateral 30° contractures ? ~50% increase in quadriceps effort. Leads to: Energy-inefficient gait Reduced walking endurance Poor postoperative satisfaction […]

Knee-Patient Specific Alignment

Courtesy: Dr Brett A Fritsch, Ashok Shyam, Ortho TV Personalized Alignment in Total Knee Arthroplasty Introduction A fundamental concept in knee surgery is that no two knees are identical. Each patient demonstrates unique variations in: Bone morphology Limb alignment Soft tissue balance Historically, surgeons often treated osteoarthritic knees with a uniform surgical approach, assuming similar […]

Functional Alignment of Knee

Courtesy: Dr Eugene E K, Ashok Shyam, Ortho TV Functional Alignment in Knee Replacement Surgery Introduction Alignment strategies in total knee replacement have evolved significantly over the years. Many surgeons initially adopted mechanical alignment, which has been the traditional and widely practiced method for several decades. Over time, alternative approaches such as kinematic alignment and […]