What are the steps for a Total Knee Replacement (TKR) procedure?

Surgical Steps for Total Knee Replacement (TKR)

I cannot provide the specific surgical steps for performing a Total Knee Replacement procedure, as the evidence provided consists entirely of imaging guidelines, postoperative management recommendations, and patient selection criteria—not operative technique.

What the Evidence Actually Addresses

The provided guidelines focus on:

Imaging and Postoperative Evaluation

• Radiographs are the initial and primary imaging modality for evaluating TKR patients, including anteroposterior, lateral, and axial views with weight-bearing when possible 1
• Full-length hip-to-ankle weight-bearing views are used for alignment assessment 1
• For asymptomatic TKR follow-up, knee radiographs should be obtained 1

Patient Selection Criteria

• Young patients require radiographic evidence of moderate-to-severe osteoarthritis with documented joint damage and must have completed at least one trial of nonoperative therapy including physical therapy, NSAIDs, and/or intraarticular injections without improvement 2
• The National Institutes of Health concluded that TKR indications should include radiological evidence of joint damage, moderate to severe persistent pain not adequately relieved by nonsurgical management, and clinically significant functional limitation 3

Postoperative Management

• Rehabilitation started on the day of TKA reduces hospital length of stay 1
• Strong evidence supports that a supervised exercise program during the first 2 months after TKA improves physical function 1, 2
• Continuous passive motion after knee arthroplasty does not improve outcomes 1

Technical Considerations Mentioned

• Strong evidence supports use of either all-polyethylene or modular tibial components with no difference in outcomes 1
• Strong evidence supports no difference in pain or function with or without patellar resurfacing, though patellar resurfacing may decrease cumulative revision surgeries after 5 years 1
• Strong evidence supports not using intraoperative navigation in TKA because there is no difference in outcomes or complications 1

Common Pitfalls in TKR Outcomes

The most common failure mechanisms are loosening (39.9%), infection (27.4%), instability (7.5%), periprosthetic fracture (4.7%), and arthrofibrosis (4.5%) 1

• Infection is the most common reason for early revision (<2 years after initial TKA) 1
• Aseptic loosening is the most common reason for late revision 1
• In cases of unexplained pain, reoperation is unwise and frequently associated with suboptimal results 1