[Closed] Where would I find the indications for total knee replacement?

There are no set criteria. It is decision made by patient and surgeon.

Main aim is treatment of pain though - anything else is a bonus.

That help?

Yes, that helps - thanks.

Any information out there on what co-morbidities tend to lead to unsuccessful outcomes of TKR?

Our lot go on significant Xray changes to at least 2 of the 3 compartments, Oxford Knee score < 20 [url] http://www.orthopaedicscore.com/scorepages/oxford_knee_score.html [/url] and clinical exam. Plus theres all the factors that influence how well you are likely to cope with the anesthetic, surgery, recovery e.t.c., age, (Revisions are harder to do so if you are under 60 they won't be keen). Very subjective IME.

My surgeon said he wouldn't advise it for anyone who is even slightly active (i.e. under 65) as you will wear out the new joint very quickly (less than five years) and replacement of a replacement if you like carries a significant risk of complications.

Depends how you define unsuccessful. In some cases it is poor patient choice or rather operating on those who probably weren't bad enough.

Outcomes for knees are worse than hips in all hands. Poorly understood that said most still do very well..

PM me if you want more info.

as RH said..my ex mrs is an orthopedic surgeon and she said your almost always better off without unless you cant get about at all or in real discomfort.. PAIN.

on the replacing .. yes they do have a life and from the couple of folk I know personally who ve had replacement replacements the complications can be worse than the original issues and take 2 plus years to resolve..

if your wishing to ride your bike post op i'd have doubts if anything other than the canal path is realistically viable.. ( having had my ribs diced and sliced for a heart op the incidental muscle scarring took 5 years before i could sneeze without pain..)

I should point out that my knees are in great condition and i'm doing my dissertation on the impact of depression on the rehabilitation of people with oa knees.

One line of thought that i'm going down concerns outcomes of TKR in people who have depression. Something along the lines of - depression > reduced mobility > early soft tissue maladaptation > poor outcome from TKR. With the suggestion being for increased emphasis on psychological/psychosocial factors as soon as OA is diagnosed.

Interesting. IME the orthopods don't assess depression unless its already been highlighted.
Recent prospective studies on incidence of back pain have suggested that depression rather than disc bulges e.t.c on MRI are the most significant predictor of developing back pain.

Maybe some useful bits + bats [url= http://bodyinmind.org/ ]here[/url]

To the Op good subject matter, my dad has just had a total Knee replacement and in all honesty the pain was only one factor of the issue, he is 77 but has always been active but he was very depressed at the lack of mobility, he is now six weeks post Op and still on a stick but he is happy as larry as he can walk to the local co-op again and get his paper and bread. The independance he has regained and his general attitude is better than when he was on the waiting list.

Good luck with the paper.

I think the point is valid although poor outcomes in TKR can often be multifactorial.

Do you want to look purely at rehab or at outcomes?

Jet26 - the paper is to have the title of "Influence of depression on rehabilitation in osteoarthritis of the knee"

So I'm planning on looking to identify where healthcare input has the most benefit, whether that be early surgical or psychological intervention, a move towards group interventions, preventative education programmes it's too early to say.

The only thing that I've found so far, is that in those with depression and mild/moderate radiographic changes their VAS pain levels are the same as those with no psychological issues but with severe radiographic changes.

I'll be looking at outcomes as well to see if I can form some sort of evidence base on which to build a further study.

Theres a substantial body of evidence linking pain scores and depression. Pain has been shown in several fields to be a poor indicator of tissue damage. If someone has started to develop chronic pain with the associated neuroplastic changes in the dorsal horn, PAG and amygdala activity e.t.c. surgery to the knee may have little impact on pain levels.
Shouldn't be too tricky to get an orthopod + ethics committee on board + hand out HADS, oxford score + get a crude grading of plain film xrays pre + post surgery. Keep us posted.