Case Study: Right Total Knee Arthroplasty – 51 year old male

A 51 year old male with a history of prior right knee arthroscopy procedures, both performed by 2 surgeons, the first in 2008 and the second in 2010. Patient stated that he recalls a work-related injury while he was employed as a Warehouse worker, patient recalls moving a pallet which slipped off of a shelving plane falling on his right knee onsetting the original knee injuries and pain in 2008.

The prior procedures helped the patients pain, however the second procedure did not provide great relief, he stated he has been in pain for approximately 8 years. The patient has not been able to return to work on complete activities of daily living without pain, he stated that this pain has hindered a substantial amount of his life. He states he cannot walk his dog, or go to his mailbox to retrieve the mail without frequent stops and pain levels increased.

Patient couldn’t sit for long periods of times and ROM , flexion and extension were 10 degrees which hindered elevation. Outpatient physical therapy services aggravated the patients pain levels, after 12 weeks of completing visits there has been no change in the patient’s condition. Pain management medication regime was with no help as well. The pain has worsened over the past 1 year with no particular onset or event that could cause the pain scale of 8/10, this caused the patient to undergo a sequence of cortisone injections which provided relief for just 3 weeks.

During the consultation and subsequent office visits the patient displayed extreme discomfort; Films revealed Moderate hypertrophic degenerative changes of the knee and patellar joint most prominently involved is lateral compartment. There are moderate osteoarthritic degenerative changes. Patient considered a Right TKA using a Conformis protocol. Patient revealed nor showed any additional medical conditions or complications and was overall healthy, making him a great candidate for surgery.

Patient underwent a Right Knee Arthroplasty using a conformis knee system, 8mm posterior stabilized polyethylene with iTotal tibial tray with iTotal femoral implant with 32 mm, 6mm thickness polyethylene with an 8 mm polyethylene insert. Right knee was draped and prepped using sterilization precautions. A straight incision was placed over the knee joint after exsanguinating the extremity.

Skin and subcutaneous tissues were incised. Medial parapatellar arthrotomy was performed. Attention was then turned towards the femur. The distal femoral resection guide was placed into position. The distal femoral resection guide was placed into position. The distal resection was made, The anterior, posterior chamfer and oblique cuts were then made using the resection guide. Attention was then turned towards the tibia. The tibial resection was performed. The alignments were checked with the knee extended. The patella was everted.

Patellar resection was performed. Drill holes were made in the patella. Trial patella was then placed into position. Attention was then turned towards the femur after balancing the knee and after removing the ACL and remainder of the curciates. The notch cut performed. The trial femur was placed into position. Trial tibia was placed into position Poly was placed into position. Full extension of the knee was achieved. The knee had full flexion intraoperatively. The patellar tracking was excellent. The trial components were then removed.

Injection was given for postoperative pain control. Femur was cemented into position. Excess cement was removed. Tibia was cemented into position. Excess cement was removed. Poly was placed into position, and the knee was reduced and held in full extension with the bump under the anchor. Patella was then cemented into position. Excess cement was removed. After the cement hardened, the patellar clamp was removed. A thorough lavage was given. Medial parapatellar arthrotomy was closed with Vicryl and Stratafix.

The cutaneous tissues were closed Vicryl, subcuticular tissues were closed with 2-0 Vicryl, and the skin was closed using staples. Sterile dressing was placed over the wound. Patient was transferred to the post operative care unit in stable condition. Patient was discharged after 36 hours with no fever, signs of infection.

Patient underwent an Right Total Knee Arthroplasty using a conformis protocol successfully. Post Operative film revealed Patient is status post right total knee replacement. There is satisfactory alignment of the prosthesis. There is no loosening. There is no acute fracture. There is soft tissue swelling consistent with the recent surgery. Patient participated in post operative outpatient physical therapy services including range of motion and strengthening for 6 weeks.

Patient returned for a 3 month follow up with full weight bearing, substantial range of motion and 0/10 pain scale. Patient states he is now able to go on extended walks with his dog and has began working part-time in the warehouse as a data clerk. Patient is required to walk, stand and sit for extended periods of time and acknowledges 0 discomfort or pain in the interim. Patient continues to follow up as needed.