NEW TECHNOLOGY BEING REVIEWED: TOTAL KNEEREPLACEMENT

TKR is a surgical procedure in which an artificial joint or prosthesis replaces a damaged knee joint. The primary indication for TKR is pain, followed by functional ability. Usually, a person's daily activities must be significantly affected by pain and functional limitations for him or her to be considered a candidate for TKR. Most referrals for pain or functional limitations to orthopedic surgeons come from family physicians (90%); however, some come from rheumatologists (10%). The mean length of hospital stay for TKR is 5 days. Most patients undergo spinal anesthesia. The surgical procedure typically lasts 2 hours. After the patient is discharged from hospital, rehabilitation is prescribed, either on an inpatient basis at a rehabilitation hospital or through outpatient care with a Community Care Access Centre (CCAC). Patients undergo short-term deep vein thrombosis prevention treatment after joint replacement (for 1 to 6 weeks). Patients are also given antibiotics for 24 hours immediately following the surgery to prevent infection. Follow-up usually occurs at 6 weeks, 12 weeks, 1 year, and then every 2 years. The type of prosthesis offered depends upon the patient's age, weight, gender, anatomy, activity level, medical history, and general health. The device's performance record and the surgeon's experience with the device also influence the decision. There are 5-10 manufacturers licensed to distribute knee replacement components in Canada. There are 3 basic types of knee replacement prostheses

Risks and Complications Associated With Knee Replacement The most common risks and complications associated with knee replacement are deep venous thrombosis (DVT), infection, stiffness, loosening, and osteolysis (the softening and loss of bone). DVT is the formation of blood clots in large veins, usually in the legs or pelvis. It is more likely to occur after surgery involving the lower body compared to other surgeries. To prevent DVT, patients are treated with heparin prophylactically and/or given support stockings to wear. Patients are also given antibiotics for 24 hours after surgery to minimize the risk of infection. Stiffness is another associated complication. In most patients, it can be avoided by keeping the knee moving in the days and weeks following surgery. In terms of revisions, one of the primary reasons why joint replacements fail is due to loosening of the prosthesis from the bone. As technology continues to improve, improvements will be made to the fixation