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The Bristol Orthopaedic

& Sports Injury Clinic

St Mary's Hospital

Upper Byron Place

Bristol BS8 1JU

Tel: 0117 970

6655 0117 970

6655

e-mail

Total Knee Arthroplasty - TKR - Introduction

What is Total Knee Replacement (Arthroplasty)

Total knee arthroplasty is undertaken for knee

arthritis. With age or following rheumatoid arthritis the weight bearing surfaces of the

knee joint become worn away. They are no longer smooth and free running and this

leads to stiffness and pain. Eventually the joint wears away to such an extent that the

bone of the femur grinds on the bone of the tibia. Joint replacement is then required. New

technology, new techniques and new types of knee replacements have made this

procedure in recent years very successful and the results are now as good or better than

hip replacement.

When the arthritis is severe in one compartment, in a younger patient (under 65) only the

damaged half of the knee may be removed and replaced; a unicompartmental knee

replacement. Alternately just the patella-femoral joint may be affected and a patella-

femoral knee replacement may be appropriate. The surgery and post-operative treatment

and recovery might be more rapid than for total knee replacement. When the arthritis is

severe effecting all compartments, or in the presence of rheumatoid arthritis or in older 

patients, the whole knee joint is removed and replaced. In very special cases knee

replacement may be used in younger patients when a special type of knee replacement

will be used, possibly without the use of cement.

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 A total knee replacement replaces the surfaces of the knee

with plastic and metal components. The femoral replacement is a smooth metal

component which fits snugly over the end of the bone. The tibial replacement is in two

parts, a metal base plate sitting on the bone and a plastic insert which sits between the

metal base on the tibial and the f emoral component. If necessary the patella surface

(under the knee cap) is replaced with a plastic button which glides over the metal surface

of the femoral replacement. However, the patella is occasionally satisfactory and may not

require replacement.

The components are usually cemented to the bones in order to secure fixation. In certain

circumstances special components may be "press fitted" to the bones without the

additional use of cement. These components use micro-porous metallic surfaces and

may have an additional hydroxyapatite coating to promote osteo-integration or bonding to

the bone. These techniques may be considered and appropriate for younger patients.

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